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Hart S, Howard G, Cummings D, Albright KC, Reis P, Howard VJ. Differences in Receipt of Neurologist Evaluation During Hospitalization for Ischemic Stroke by Race, Sex, Age, and Region: The REGARDS Study. Neurology 2024; 102:e209200. [PMID: 38484277 DOI: 10.1212/wnl.0000000000209200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Improving access to health care providers with clinical expertise in stroke care may influence the use of recommended strategies for reducing disparities in quality of care. Few studies have examined differences in the receipt of evaluation by neurologists during the hospital stay. We examined the proportion of individuals hospitalized for acute ischemic stroke who received evaluation by a neurologist during the hospital stay and characterized differences in receipt of neurologist evaluation by race (Black vs White), sex, age, and study region (Stroke Belt residence vs other) among those experiencing a stroke who were participating in a national cohort study. METHODS This cross-sectional study was conducted using medical record data abstracted from 1,042 participants enrolled in the national Reasons for Geographic and Racial Differences in Stroke cohort study (2003-2007) who experienced an adjudicated ischemic stroke between 2003 and 2016. Participants with a history of stroke before baseline, in-hospital death, hospice discharge following their stroke, or incomplete records were excluded resulting in 839 cases. Differences were assessed using modified Poisson regression adjusting for participant-level and hospital-level factors. RESULTS Of the 839 incident strokes, 722 (86%) received evaluation by a neurologist during the hospital stay. There were no significant differences by age, race, or sex, yet Stroke Belt residents and those receiving care in rural hospitals were significantly less likely to receive neurologist evaluation compared with non-Stroke Belt residents (relative risk [RR] 0.95; 95% CI 0.90-1.01) and participants receiving care in urban hospitals (RR 0.74; 95% CI 0.63-0.86). Participants with a greater level of poststroke functional impairment (modified Rankin scale) and those with a greater number of risk factors were more likely to receive neurologist evaluation compared with those with lower levels of poststroke functional impairment (RR 1.04; 95% CI 1.01-1.06) and fewer risk factors (RR 1.02; 95% CI 1.00-1.04). DISCUSSION While differences in access to neurologists during the hospital stay were partially explained by patient need in our study, there were also significant differences in access by region and urban-rural hospital status. Ensuring access to neurologists during the hospital stay in such settings may require policy-level and/or system-level changes.
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Affiliation(s)
- Stephanie Hart
- From the School of Nursing (S.H.), and Duke Clinical and Translational Science Institute (S.H.), Duke University, Durham, NC; School of Public Health (G.H., V.J.H.), University of Alabama at Birmingham; Department of Public Health (D.C.), Brody School of Medicine, East Carolina University, Greenville, NC; Department of Neurology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and College of Nursing (P.R.), East Carolina University, Greenville, NC
| | - George Howard
- From the School of Nursing (S.H.), and Duke Clinical and Translational Science Institute (S.H.), Duke University, Durham, NC; School of Public Health (G.H., V.J.H.), University of Alabama at Birmingham; Department of Public Health (D.C.), Brody School of Medicine, East Carolina University, Greenville, NC; Department of Neurology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and College of Nursing (P.R.), East Carolina University, Greenville, NC
| | - Doyle Cummings
- From the School of Nursing (S.H.), and Duke Clinical and Translational Science Institute (S.H.), Duke University, Durham, NC; School of Public Health (G.H., V.J.H.), University of Alabama at Birmingham; Department of Public Health (D.C.), Brody School of Medicine, East Carolina University, Greenville, NC; Department of Neurology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and College of Nursing (P.R.), East Carolina University, Greenville, NC
| | - Karen C Albright
- From the School of Nursing (S.H.), and Duke Clinical and Translational Science Institute (S.H.), Duke University, Durham, NC; School of Public Health (G.H., V.J.H.), University of Alabama at Birmingham; Department of Public Health (D.C.), Brody School of Medicine, East Carolina University, Greenville, NC; Department of Neurology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and College of Nursing (P.R.), East Carolina University, Greenville, NC
| | - Pamela Reis
- From the School of Nursing (S.H.), and Duke Clinical and Translational Science Institute (S.H.), Duke University, Durham, NC; School of Public Health (G.H., V.J.H.), University of Alabama at Birmingham; Department of Public Health (D.C.), Brody School of Medicine, East Carolina University, Greenville, NC; Department of Neurology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and College of Nursing (P.R.), East Carolina University, Greenville, NC
| | - Virginia J Howard
- From the School of Nursing (S.H.), and Duke Clinical and Translational Science Institute (S.H.), Duke University, Durham, NC; School of Public Health (G.H., V.J.H.), University of Alabama at Birmingham; Department of Public Health (D.C.), Brody School of Medicine, East Carolina University, Greenville, NC; Department of Neurology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and College of Nursing (P.R.), East Carolina University, Greenville, NC
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Sawadogo W, Adera T, Burch JB, Alattar M, Perera R, Howard VJ. Sleep duration and all-cause mortality among stroke survivors. J Stroke Cerebrovasc Dis 2024; 33:107615. [PMID: 38307468 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Post stroke sleep duration could increase the risk of death. This study tested the hypothesis that inadequate sleep duration is associated with increased mortality among stroke survivors. METHODS The REasons for Geographic And Racial Differences in Stroke (REGARDS), a national population-based longitudinal study, was the data source. Sleep duration was ascertained between 2013 and 2016 among stroke survivors who were subsequently followed up until death or censored on December 31, 2022. Sleep duration was estimated as the difference between wake-up time and bedtime to which was subtracted the time spent in bed without sleep. Cox proportional hazards regression models were employed to investigate the association between sleep duration and all-cause mortality adjusting for demographic factors, socioeconomic factors, behavioral factors, and co-morbidities. RESULTS A total of 468 non-Hispanic Black and White stroke survivors were included in this analysis. The mean age was 76.3 years, 52.6% were females and 56.0% were non-Hispanic White individuals. The distribution of short (≤6 h), adequate (7.0-8.9 h), and long sleep (≥9 h) was 30.3%, 44.7%, and 25%, respectively. Over a mean follow-up of 5.0 years, 190 (40.6%) deaths occurred. Compared to stroke survivors with adequate sleep (7.0-8.9 h), stroke survivors with long sleep (≥9 h) were at increased risk of all-cause mortality (HR=1.46, 95% CI=1.01, 2.12). However, short sleep (≤6 h) was not significantly associated with an increased risk of all-cause mortality (HR=1.31, 95% CI=0.90, 1.91). Subgroup analyses indicated higher risk in the age <75 years, females, non-Hispanic Black individuals, and those living in the Stroke Belt region, but those differences were not statistically significant. CONCLUSION In this study of stroke survivors, 9 hours or more of sleep per day was associated with an increased risk of all-cause mortality. This finding suggests that excessive sleep duration may be a warning sign of poor life expectancy in stroke survivors.
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Affiliation(s)
- Wendemi Sawadogo
- Department of Public Health, College of Human and Health Services, Southern Connecticut State University, New Haven, CT, United States; Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States.
| | - Tilahun Adera
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - James B Burch
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Maha Alattar
- Division of Adult Neurology, Sleep Medicine, Vascular Neurology, Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert Perera
- Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Robbins R, Yuan Y, Johnson DA, Long DL, Molano J, Kleindorfer D, Petrov ME, Howard VJ. Sleep Apnea and Incident Stroke in a National Cohort of Black and White Adults. Neurology 2024; 102:e209171. [PMID: 38447086 DOI: 10.1212/wnl.0000000000209171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Racial/ethnic differences have been documented in the relationship between obstructive sleep apnea (OSA) and stroke incidence, yet racial differences in OSA symptoms or treatment and their relationship with stroke incidence are underexplored and may contribute to stroke disparities. We comprehensively examined OSA symptoms and their relationships to stroke incidence by race/ethnicity. METHODS Data were collected from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort of Black and White individuals in the United States. Participants free from a stroke diagnosis at baseline were included. Participants self-reported the following: (1) snoring; (2) daytime sleepiness; (3) provider-diagnosed sleep apnea (PDSA); and (4) treatment for PDSA using positive airway pressure (PAP). OSA risk was categorized as high or low based on the Berlin Sleep Questionnaire. Incident stroke was defined as first occurrence of stroke over an average of 12 (SD 3.9) years of follow-up. We report the relationships between snoring, OSA risk, PDSA, PAP therapy use, and incident stroke by race/ethnicity using Cox proportional hazards models after adjusting for demographic and socioeconomic factors and stroke risk factors. RESULTS Among the 22,192 participants (mean age [SD] 64.2[9.1] years), 38.1% identified as Black. Overall, snoring was not associated with incident stroke (hazard ratio [HR] 0.98, 95% CI 0.85-1.13). However, among White individuals but not Black individuals, high OSA risk and PDSA were associated with incident stroke (HR 1.22, 95% CI 1.01-1.47; HR 1.33, 95% CI 1.04-1.70, respectively). PAP therapy use among those with PDSA (compared with non-PDSA) was associated with incident stroke in White individuals (HR 1.38, 95% CI 1.05-1.80). PAP therapy use among those with PDSA (compared with those with PDSA without PAP therapy use) was associated with reduced risk of incident stroke in Black (HR 0.39, 95% CI 0.17-0.91) but not White (HR 0.63, 95% CI 0.37-1.10) individuals. DISCUSSION White individuals with high OSA risk and those with PDSA with or without PAP therapy use were at increased incident stroke risk, whereas Black individuals reporting PDSA and PAP had reduced incident stroke risk relative to those not using PAP. Future research is needed to understand the mechanisms underlying racial differences in OSA and stroke such as differences in assessment modes and treatment.
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Affiliation(s)
- Rebecca Robbins
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Ya Yuan
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Dayna A Johnson
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - D Leann Long
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Jennifer Molano
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Dawn Kleindorfer
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Megan E Petrov
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
| | - Virginia J Howard
- From the Division of Sleep and Circadian Disorders (R.R.), Departments of Medicine and Neurology and Division of Sleep Medicine (R.R.), Harvard Medical School, Boston, MA; Departments of Biostatistics (Y.Y., D.L.L.) and Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology (D.A.J.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Neurology and Rehabilitation Medicine (J.M.), University of Cincinnati, OH; Department of Neurology (D.K.), University of Michigan Medical Center, Ann Arbor; and Edson College of Nursing and Health Innovation (M.E.P.), Arizona State University, Phoenix
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Howard G, Cushman M, Blair J, Wilson NR, Yuan Y, Safford MM, Levitan EB, Judd SE, Howard VJ. Comparative Discrimination of Life's Simple 7 and Life's Essential 8 to Stratify Cardiovascular Risk: Is the Added Complexity Worth It? Circulation 2024; 149:905-913. [PMID: 37830200 PMCID: PMC10948319 DOI: 10.1161/circulationaha.123.065472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Life's Simple 7 (LS7) is an easily calculated and interpreted metric of cardiovascular health based on 7 domains: smoking, diet, physical activity, body mass index, blood pressure, cholesterol, and fasting glucose. The Life's Essential 8 (LE8) metric was subsequently introduced, adding sleep metrics and revisions of the previous 7 domains. Although calculating LE8 requires additional information, we hypothesized that it would be a more reliable index of cardiovascular health. METHODS Both the LS7 and LE8 metrics yield scores with higher values indicating lower risk. These were calculated among 11 609 Black and White participants free of baseline cardiovascular disease (CVD) in the Reasons for Geographic and Racial Differences in Stroke study, enrolled in 2003 to 2007, and followed for a median of 13 years. Differences in 10-year risk of incident CVD (coronary heart disease or stroke) were calculated as a function LS7, and LE8 scores were calculated using Kaplan-Meier and proportional hazards analyses. Differences in incident CVD discrimination were quantified by difference in the c-statistic. RESULTS For both LS7 and LE8, the 10-year risk was approximately 5% for participants around the 99th percentile of scores, and a 4× higher 20% risk for participants around the first percentile. Comparing LS7 to LE8, 10-year risk was nearly identical for individuals at the same relative position in score distribution. For example, the "cluster" of 2013 participants with an LS7 score of 7 was at the 35.8th percentile in distribution of LS7 scores, and had an estimated 10-year CVD risk of 8.4% (95% CI, 7.2%-9.8%). In a similar location in the LE8 distribution, the 1457 participants with an LE8 score of 60±2.5 at the 39.4th percentile of LE8 scores had a 10-year risk of CVD of 8.5% (95% CI, 7.1%-10.1%), similar to the cluster defined by LS7. The age-race-sex adjusted c-statistic of the LS7 model was 0.691 (95% CI, 0.667-0.705), and 0.695 for LE8 (95% CI, 0.681-0.709) (P for difference, 0.12). CONCLUSIONS Both LS7 and LE8 were associated with incident CVD, with discrimination of the 2 indices practically indistinguishable. As a simpler metric, LS7 may be favored for use by the general population and clinicians.
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Affiliation(s)
- George Howard
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Mary Cushman
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Jessica Blair
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Nicole R. Wilson
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Ya Yuan
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Monika M. Safford
- Department of Internal Medicine, Weill Cornell Medical Center, New York, NY
| | - Emily B. Levitan
- Department of Epidemiology, UAB School of Public Health, Birmingham, AL
| | - Suzanne E. Judd
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
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Plante TB, Juraschek SP, Howard G, Howard VJ, Tracy RP, Olson NC, Judd SE, Kamin Mukaz D, Zakai NA, Long DL, Cushman M. Cytokines, C-Reactive Protein, and Risk of Incident Hypertension in the REGARDS Study. Hypertension 2024. [PMID: 38487890 DOI: 10.1161/hypertensionaha.123.22714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hypertension is a highly prevalent cardiovascular disease risk factor that may be related to inflammation. Whether adverse levels of specific inflammatory cytokines relate to hypertension is unknown. The present study sought to determine whether higher levels of IL (interleukin)-1β, IL-6, TNF (tumor necrosis factor)-α, IFN (interferon)-γ, IL-17A, and CRP (C-reactive protein) are associated with a greater risk of incident hypertension. METHODS The REGARDS study (Reasons for Geographic and Racial Difference in Stroke) is a prospective cohort study that recruited 30 239 community-dwelling Black and White adults from the contiguous United States in 2003 to 2007 (visit 1), with follow-up 9 years later in 2013 to 2016 (visit 2). We included participants without prevalent hypertension who attended follow-up 9 years later and had available laboratory measures and covariates of interest. Poisson regression estimated the risk ratio of incident hypertension by level of inflammatory biomarkers. RESULTS Among 1866 included participants (mean [SD] aged of 62 [8] years, 25% Black participants, 55% women), 36% developed hypertension. In fully adjusted models comparing the third to first tertile of each biomarker, there was a greater risk of incident hypertension for higher IL-1β among White (1.24 [95% CI, 1.01-1.53]) but not Black participants (1.01 [95% CI, 0.83-1.23]) and higher TNF-α (1.20 [95% CI, 1.02-1.41]) and IFN-γ (1.22 [95% CI, 1.04-1.42]) among all participants. There was no increased risk with IL-6, IL-17A, or CRP. CONCLUSIONS Higher levels of IL-1β, TNF-α, and IFN-γ, representing distinct inflammatory pathways, are elevated in advance of hypertension development. Whether modifying these cytokines will reduce incident hypertension is unknown.
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Affiliation(s)
- Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington. (T.B.P., D.K.M., N.A.Z., M.C.)
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Lahey Clinic/Harvard Medical School, Boston, MA (S.P.J.)
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham. (G.H., S.E.J.)
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. (V.J.H.)
| | - Russell P Tracy
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.T., N.C.O., N.A.Z., D.L.L.)
| | - Nels C Olson
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.T., N.C.O., N.A.Z., D.L.L.)
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham. (G.H., S.E.J.)
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington. (T.B.P., D.K.M., N.A.Z., M.C.)
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington. (T.B.P., D.K.M., N.A.Z., M.C.)
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.T., N.C.O., N.A.Z., D.L.L.)
| | - D Leann Long
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.T., N.C.O., N.A.Z., D.L.L.)
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington. (T.B.P., D.K.M., N.A.Z., M.C.)
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington. (M.C.)
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Zhu W, Li Y, Zhao C, Howard VJ, Wadley VG, Judd SE, Colabianchi N, McClure LA, Hooker SP, Sun Y. Changes in Adiposity and Cognitive Function in Older Adults: The REGARDS Study. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad184. [PMID: 38134240 PMCID: PMC10873843 DOI: 10.1093/geronb/gbad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Adiposity may have a role in the risk of dementia. Fewer studies have focused on the relationship between change in adiposity and cognitive decline. Our study aimed to explore the association between the change in adiposity and cognitive function in Black and White older adults. METHODS The participants were 12,204 older adults without cognitive impairment (62.8 ± 8.0 years) in the United States. The percent body mass index change (%BMI change) and percent waist circumference change (%WC change) were measured at 2 in-home visits (first: 2003-2007, second: 2013-2016). Cognitive status was assessed by the Six-Item Screener annually. Memory and executive function were measured by word list learning, MOCA recall and orientation, and letter and animal fluency every 2 years. Logistic regression or linear regression models were used to estimate the relationship between percent change in adiposity and cognitive function. RESULTS After 12.7 ± 1.7 years, a greater decrease in %BMI change or %WC change was significantly associated with a higher risk of cognitive impairment. Compared to older adults with -5% ≤ change ≤ 5% from baseline, a significantly higher risk of cognitive impairment and greater loss in memory and executive function were found among those who experienced more than a 10% decline in %BMI change or %WC change. Older adults who experienced a 5%-10% decrease in %BMI change had a higher risk of cognitive impairment and greater loss of memory compared to those with -5% ≤ change ≤ 5%. DISCUSSION A greater decrease in %BMI (>5%) and %WC (>10%) change was associated with greater cognitive loss observed over time.
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Affiliation(s)
- Wenfei Zhu
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Yanbing Li
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Chenxi Zhao
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G Wadley
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Leslie A McClure
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, USA
| | - Yuliang Sun
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
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Kim JS, Sun Y, Balte P, Cushman M, Boyle R, Tracy RP, Styer LM, Bell TD, Anderson MR, Allen NB, Schreiner PJ, Bowler RP, Schwartz DA, Lee JS, Xanthakis V, Doyle MF, Regan EA, Make BJ, Kanaya AM, Wenzel SE, Coresh J, Isasi CR, Raffield LM, Elkind MSV, Howard VJ, Ortega VE, Woodruff P, Cole SA, Henderson JM, Mantis NJ, Parker MM, Demmer RT, Oelsner EC. Demographic and Clinical Factors Associated With SARS-CoV-2 Spike 1 Antibody Response Among Vaccinated US Adults: the C4R Study. Nat Commun 2024; 15:1492. [PMID: 38374032 PMCID: PMC10876680 DOI: 10.1038/s41467-024-45468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
This study investigates correlates of anti-S1 antibody response following COVID-19 vaccination in a U.S. population-based meta-cohort of adults participating in longstanding NIH-funded cohort studies. Anti-S1 antibodies were measured from dried blood spots collected between February 2021-August 2022 using Luminex-based microsphere immunoassays. Of 6245 participants, mean age was 73 years (range, 21-100), 58% were female, and 76% were non-Hispanic White. Nearly 52% of participants received the BNT162b2 vaccine and 48% received the mRNA-1273 vaccine. Lower anti-S1 antibody levels are associated with age of 65 years or older, male sex, higher body mass index, smoking, diabetes, COPD and receipt of BNT16b2 vaccine (vs mRNA-1273). Participants with a prior infection, particularly those with a history of hospitalized illness, have higher anti-S1 antibody levels. These results suggest that adults with certain socio-demographic and clinical characteristics may have less robust antibody responses to COVID-19 vaccination and could be prioritized for more frequent re-vaccination.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yifei Sun
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Pallavi Balte
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Rebekah Boyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Linda M Styer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Taison D Bell
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - David A Schwartz
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joyce S Lee
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vanessa Xanthakis
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sally E Wenzel
- Department of Medicine, Department of Immunology, and Department of Environmental Medicine and Occupational Health, University of Pittsburgh School of Medicine, School of Public Health, Pittsburgh, PA, USA
| | - Josef Coresh
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joel M Henderson
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Nicholas J Mantis
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
| | - Monica M Parker
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Division of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Lo AX, Wadley VG, Brown CJ, Long DL, Crowe M, Howard VJ, Kennedy RE. Life-Space Mobility: Normative Values From a National Cohort of U.S. Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glad176. [PMID: 37480583 PMCID: PMC10803118 DOI: 10.1093/gerona/glad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Life-space mobility, which measures the distance, frequency, and independence achieved as individuals move through their community, is one of the most important contributors to healthy aging. The University of Alabama at Birmingham Life-Space Assessment (LSA) is the most commonly used measure of life-space mobility in older adults, yet U.S. national norms for LSA have not previously been reported. This study reports such norms based on age and sex among community-dwelling older adults. METHODS A cross-sectional analysis using data from the national REasons for Geographic and Racial Disparities in Stroke cohort study. LSA data were available for 10 118 Black and White participants over age 50, which were grouped by age (in 5-year increments) and sex, weighted for the U.S. national population. Correlations were calculated between LSA and measures of functional and cognitive impairment and physical performance. RESULTS The weighted mean LSA ranged from 102.9 for 50-54-year-old males to 69.5 for males aged 85 and older, and from 102.1 for 50-54-year-old females to 60.1 for females aged 85 and older. LSA was strongly correlated with measures of timed walking, activities of daily living, cognition, depressive symptoms, and quality of life (all p < .001). CONCLUSIONS We report U.S. national norms for LSA among community-dwelling Black and White older adults. These norms can serve as a reference tool for determining if clinical and research samples have greater or lesser life-space mobility than typical older adults in the United States for their age and sex.
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Affiliation(s)
- Alexander X Lo
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Virginia G Wadley
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cundiff JM, Bennett A, Williams A, Cushman M, Howard VJ. Association between psychosocial factors and C-reactive protein across income, race, and sex. Health Psychol 2024; 43:7-18. [PMID: 37428772 PMCID: PMC10776820 DOI: 10.1037/hea0001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE A health disparity is a health difference that adversely affects disadvantaged populations, and thus could plausibly be due to social factors. Biopsychosocial processes that contribute to health disparities are not well-understood. Establishing whether candidate biomarkers are similarly associated with biologically relevant psychosocial constructs across health disparity groups is a current gap in our understanding. METHOD This study examined associations between perceived stress, depressive symptoms, and social support with C-reactive protein (CRP) and whether associations varied by race, sex, or income in 24,395 Black and White adults aged 45 years or older from the REGARDS population-based national cohort. RESULTS The association between depressive symptoms and CRP was slightly larger at higher (vs. lower) income levels and larger for men (vs. women) but did not vary by race. Associations between stress and CRP and social support and CRP were not moderated by income, race, or sex. An interaction between race and income, evidenced that higher income was more strongly associated with lower CRP in White participants compared to Black participants, consistent with the idea of "diminishing returns" of income for the health of Black Americans. CONCLUSIONS Basic associations between these psychosocial factors and CRP are small and generally similar across income, race, and sex. Black and lower-income Americans likely evidence higher CRP due to greater exposure to psychosocial risk factors rather than increased biological vulnerability to these exposures. Additionally, given small associations, CRP should not be used as a proxy for the construct of psychosocial stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Sawyer RP, Bennett A, Blair J, Molano J, Timmerman E, Foster F, Karkoska K, Hyacinth HI, Manly JJ, Howard VJ, Petrov ME, Hoffmann CM, Yu F, Demel SL, Aziz Y, Hooper D, Hill EJ, Johnson J, Pounders J, Shatz R. History of obstructive sleep apnea associated with incident cognitive impairment in white but not black individuals in a US national cohort study. Sleep Med 2023; 112:1-8. [PMID: 37801859 DOI: 10.1016/j.sleep.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND We sought to determine if risk for obstructive sleep apnea (OSA), a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals. METHODS To determine whether the risk for OSA, a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals; data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) was used. Participants that completed the sleep questionnaire module, had baseline cognitive assessment, and at least one cognitive assessment during follow-up were included. Risk of OSA was determined based on Berlin Sleep Questionnaire. History of sleep apnea was determined based on structured interview questions. Optimally treated OSA was defined as treated sleep apnea as at least 4 h of continuous positive airway pressure use per night for ≥5 nights per week. RESULTS In 19,017 participants stratified by race, White participants with history of OSA were 1.62 times more likely to have incident cognitive impairment compared to White participants without history of OSA after adjusting for demographic characteristics, history, and lifestyle factors (OR = 1.62, 95% CI = 1.05-2.50, p-value = 0.03). This relationship was not seen in Black participants (OR = 0.92, 95% CI = 0.60-1.43, p-value = 0.72). DISCUSSION A previous diagnosis of OSA is associated with incident cognitive impairment in White Americans but not Black Americans. Further investigations are required to determine the mechanism for this difference.
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Affiliation(s)
- Russell P Sawyer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA.
| | - Aleena Bennett
- Biostatistics Department, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jessica Blair
- Biostatistics Department, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jennifer Molano
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Emerlee Timmerman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Forrest Foster
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Kristine Karkoska
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Hyacinth I Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Jennifer J Manly
- Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York City, NY, 10032, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Megan E Petrov
- Center for Innovation in Healthy & Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Coles M Hoffmann
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Fang Yu
- Center for Innovation in Healthy & Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Stacie L Demel
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Destiny Hooper
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Emily J Hill
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Jamelle Johnson
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Johnson Pounders
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45219, USA
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11
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Gupta A, Wilson LE, Pinheiro LC, Herring AH, Brown T, Howard VJ, Akinyemiju TF. Association of educational attainment with cancer mortality in a national cohort study of black and white adults: A mediation analysis. SSM Popul Health 2023; 24:101546. [PMID: 37954012 PMCID: PMC10637994 DOI: 10.1016/j.ssmph.2023.101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
Background Low educational attainment is associated with excess cancer mortality. However, the mechanisms driving this association remain unknown. Methods Using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we evaluated the associations of participant and parental/caregiver education with cancer mortality using Cox proportional hazards models, adjusting for socio-demographic characteristics and health conditions. We used principal components analysis to generate indices of measures representing the social determinants of health (SDOH) and health behaviors. We used structural equation modeling to determine if the association between educational attainment and cancer mortality was mediated by these domains. Results Among 30,177 REGARDS participants included in this analysis, 3798 (12.6%) had less than a high school degree. In fully adjusted models, those without a high school education experienced about 50% greater risk of death than high school graduates and higher (White participants HR: 1.47; 95% CI: 1.23, 1.76 and Black HR: 1.54; 95% CI: 1.33, 1.79). There was evidence of a modest mediation effect for the association between education and cancer mortality by the SDOH domain score (White total effect HR: 1.25; 95% CI: 1.18, 1.33, indirect effect HR: 1.04; 95% CI: 1.03, 1.05, direct effect HR: 1.21; 95% CI: 1.14, 1.28 and Black total effect HR: 1.24; 95% CI: 1.18, 1.29, indirect effect HR: 1.04; 95% CI: 1.03, 1.05, direct effect HR: 1.19; 95% CI: 1.14, 1.24). There was no evidence of mediation by the health behaviors score. No significant associations were found for female caregiver/mother's or male caregiver/father's education (N = 13,209). Conclusions In conclusion, participant education was strongly associated with cancer mortality, and this association was partially mediated by the SDOH domain score.
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Affiliation(s)
- Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Lauren E. Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Amy H. Herring
- Department of Statistical Science, Global Health, Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Tyson Brown
- Department of Sociology, Duke University, Durham, NC, USA
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Tomi F. Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Velazquez-Kronen R, MacDonald LA, Akinyemiju TF, Cushman M, Howard VJ. Shiftwork, long working hours and markers of inflammation in a national US population-based sample of employed black and white men and women aged ≥45 years. Occup Environ Med 2023; 80:635-643. [PMID: 37813482 PMCID: PMC10936900 DOI: 10.1136/oemed-2023-108902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Work schedule demands contribute to circadian disruption and may influence health via an inflammatory response. We examined the impact of shiftwork and long work hours on inflammation in a national US sample. METHODS Participants included 12 487 employed black and white men and women aged ≥45 years enrolled in the REasons for Geographic and Racial Differences in Stroke Study who completed an occupational questionnaire (2011-2013) and clinical examination (2013-2016). Cross-sectional associations between shiftwork and work hours with log-transformed high-sensitivity C reactive protein (CRP) and white blood cell (WBC) count were examined by multiple linear regression analysis, overall and by race-sex subgroups. RESULTS Overall, rotating shift workers had higher log-CRP concentration compared with day workers (β=0.09, 95% CI:0.02 to 0.16) and findings for WBC were null. Black women had the highest geometric mean CRP (2.82 mg/L), while white men had the highest WBC (6.35×109/L). White men who worked afternoons had higher log-CRP compared with those who worked days (β=0.20, 95% CI: 0.08 to 0.33). Black men engaged in shiftwork <10 years working ≥55 hours/week had higher log-CRP and log-WBC compared with those working days <55 hours/week (β=0.33, 95% CI: 0.02 to 0.64 and β=0.10, 95% CI: 0.003 to 0.19). Among shift workers, non-retired white women working forward and backward shift rotations had higher log-CRP compared with those working forward only (β=0.49, 95% CI: 0.02 to 0.96). CONCLUSIONS Shift workers had higher inflammatory markers compared with day workers and race-sex disparities should be examined further. These findings highlight a potential biological pathway linking work schedule demands and chronic disease.
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Affiliation(s)
- Raquel Velazquez-Kronen
- Field Research Branch, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Leslie A MacDonald
- Field Research Branch, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Tomi F Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Garg PK, Wilson N, Yuan Y, Howard VJ, Judd S, Howard G, Soliman EZ. Association of hypertension severity and control with risk of incident atrial fibrillation: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Clin Cardiol 2023; 46:1418-1425. [PMID: 37605862 PMCID: PMC10642317 DOI: 10.1002/clc.24135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The association of hypertension (HTN) severity and control with the risk of incident atrial fibrillation (AF) is unclear. HYPOTHESIS Increased HTN severity and poorer blood pressure control would be associated with an increased risk of incident AF. METHODS This analysis included 9485 participants (mean age 63 ± 8 years; 56% women; 35% Black). Participants were stratified into six mutually exclusive groups at baseline-normotension (n = 1629), prehypertension (n = 704), controlled HTN (n = 2224), uncontrolled HTN (n = 4123), controlled apparent treatment-resistant hypertension (aTRH) (n = 88), and uncontrolled aTRH (n = 717). Incident AF was ascertained at the follow-up visit, defined by either electrocardiogram or self-reported medical history of a physician diagnosis. Multivariable logistic regression analyses adjusted for demographic and clinical variables. RESULTS Over an average of 9.3 years later, 868 incident AF cases were detected. Compared to those with normotension, incident AF risk was highest for those with aTRH (controlled aTRH: odds ratio (OR) 2.95; 95% confidence interval (CI) 1.60, 5.43, & uncontrolled aTRH: OR 2.47; 95% CI 1.76, 3.48). The increase in AF risk was smaller for those on no more than three antihypertensive agents regardless of their blood pressure control (controlled OR 1.72; 95% CI 1.30, 2.29 and uncontrolled OR 1.56; 95% CI 1.14, 2.13). CONCLUSIONS The risk of developing AF is increased in all individuals with HTN. Risk is highest in those aTRH regardless of blood pressure control. A more aggressive approach that focuses on lifestyle and pharmacologic measures to either prevent HTN or better control HTN during earlier stages may be particularly beneficial in reducing related AF risk.
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Affiliation(s)
- Parveen K. Garg
- Division of CardiologyUSC Keck School of MedicineLos AngelesCaliforniaUSA
| | - Nicole Wilson
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ya Yuan
- School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Virginia J. Howard
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Suzanne Judd
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - George Howard
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Elsayed Z. Soliman
- Department of MedicineEpidemiological Cardiology Research Center (EPICARE), Section of Cardiovascular Medicine, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Elman C, Cunningham SA, Howard VJ, Judd SE, Bennett AM, Dupre ME. Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life. Soc Sci Med 2023; 335:116213. [PMID: 37717468 DOI: 10.1016/j.socscimed.2023.116213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.
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Affiliation(s)
- Cheryl Elman
- Social Science Research Institute, Duke University, Durham, NC, 27708, USA.
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Aleena M Bennett
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA; Department of Sociology, Duke University, Durham, NC 27710, USA.
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Sawyer RP, Worrall BB, Howard VJ, Crowe MG, Howard G, Hyacinth HI. Methods of a Study to Assess the Contribution of Cerebral Small Vessel Disease and Dementia Risk Alleles to Racial Disparities in Vascular Cognitive Impairment and Dementia. J Am Heart Assoc 2023; 12:e030925. [PMID: 37642037 PMCID: PMC10547311 DOI: 10.1161/jaha.123.030925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
Background Non-Hispanic Black adults have a higher proportion of vascular cognitive impairment and Alzheimer's disease and related dementias compared with non-Hispanic White adults that may be due to differences in the burden of cerebral small vessel disease and risk alleles for Alzheimer's disease and related dementias. We describe here the methods of an ancillary study to the REGARDS (Reason for Geographic and and Racial Difference in Stroke) study, which will examine the role of magnetic resonance imaging markers of cerebral small vessel disease and vascular as well as genetic risk factors for Alzheimer's disease and related dementias in racial disparity in the prevalence and trajectory of vascular cognitive impairment and dementia in non-Hispanic White and non-Hispanic Black participants. Methods In participants with no prior history of stroke who had an incident stroke or transient ischemic attack after enrollment in the study, magnetic resonance imaging scans will be evaluated using the Standards for Reporting Vascular Changes on Neuroimaging international consensus criteria and automated analysis pipelines for quantification of cerebral small vessel disease. Participants will be genotyped for APOE ε4 and TREM2 risk alleles for Alzheimer's disease and related dementias. The 6-item screener will define global cognitive function and be the primary cognitive outcome. Conclusions With at least 426 non-Hispanic Black and 463 non-Hispanic White participants who have at least 2 prior and 2 poststroke or transient ischemic attack cognitive assessments, we will have at least 80% power to detect a minimum effect size of 0.09 SD change in Z score, with correction for as many as 20 tests (ie, at P<0.0025, after adjusting for up to 20 covariates) for cognitive decline.
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Affiliation(s)
- Russell P. Sawyer
- Department of Neurology and Rehabilitation MedicineUniversity of CincinnatiOHUSA
| | - Bradford B. Worrall
- Department of Neurology and Public Health SciencesUniversity of VirginiaCharlottesvilleVAUSA
| | - Virginia J. Howard
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Michael G. Crowe
- Department of Psychology, College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamALUSA
| | - George Howard
- Department of Biostatistics, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation MedicineUniversity of CincinnatiOHUSA
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Andel R, Veal BM, Howard VJ, MacDonald LA, Judd SE, Crowe M. Retirement and cognitive aging in a racially diverse sample of older Americans. J Am Geriatr Soc 2023; 71:2769-2778. [PMID: 37465869 PMCID: PMC10526697 DOI: 10.1111/jgs.18475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults. METHODS Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study-a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z-scores for tests of verbal fluency, memory, and global function. RESULTS Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = -0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = -0.19, p < 0.001) compared with Black (Estimate = -0.07, p = 0.077) participants, twice as large in men (Estimate = -0.20, p < 0.001) compared with women (Estimate = -0.11, p < 0.001), highest among White men (Estimate = -0.22, p < 0.001) and lowest in Black women (Estimate = -0.04, p = 0.457). Greater post-retirement cognitive decline was also observed among participants who attended college (Estimate = -0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement. CONCLUSION Cognitive functioning may decline at an accelerated rate immediately post-retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging.
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Affiliation(s)
- Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
- Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Britney M. Veal
- School of Aging Studies, University of South Florida, Tampa, FL, United States
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Leslie A. MacDonald
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH, United States
| | - Suzanne E. Judd
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham AL, United States
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17
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Garg PK, Wilson N, Levitan EB, Shikany JM, Howard VJ, Newby PK, Judd S, Howard G, Cushman M, Soliman EZ. Associations of dietary patterns with risk of incident atrial fibrillation in the REasons for Geographic And Racial Differences in Stroke (REGARDS). Eur J Nutr 2023; 62:2441-2448. [PMID: 37119297 PMCID: PMC10421757 DOI: 10.1007/s00394-023-03159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND We examined whether the risk of incident atrial fibrillation (AF) in a large, biracial, prospective cohort is lower in participants who adhere to heart-healthy dietary patterns and higher in participants who adhere to less heart-healthy diets. METHODS Between 2003 and 2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 Black and White Americans aged 45 years or older. Dietary patterns (convenience, plant-based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score (MDS) were derived based on food frequency questionnaire data. The primary outcome was incident AF at the follow-up visit 2013-2016, defined by either electrocardiogram or self-reported medical history of a physician diagnosis. RESULTS This study included 8977 participants (mean age 63 ± 8.3 years; 56% women; 30% Black) free of AF at baseline who completed the follow-up exam an average of 9.4 years later. A total of 782 incident AF cases were detected. In multivariable logistic regression analyses, neither the MDS score (odds ratio (OR) per SD increment = 1.03; 95% confidence interval (CI) 0.95-1.11) or the plant-based dietary pattern (OR per SD increment = 1.03; 95% CI 0.94-1.12) were associated with AF risk. Additionally, an increased AF risk was not associated with any of the less-healthy dietary patterns. CONCLUSIONS While specific dietary patterns have been associated with AF risk factors, our findings fail to show an association between diet patterns and AF development.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, USC Keck School of Medicine, 1510 San Pablo St. Suite 322, Los Angeles, CA, 90033, USA.
| | - Nicole Wilson
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - P K Newby
- Food Matters Media, LLC, Boston, MA, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Cushman
- Departments of Medicine and Pathology, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Elsayed Z Soliman
- Department of Medicine, Epidemiological Cardiology Research Center (EPICARE), Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Ovbiagele B, Amezcua L, Cruz-Flores SC, Griffith P, Jean-Louis G, Jenkins C, Howard VJ, Smith-Byrd G. Health Disparities Research Curricula and Training Development: Recommendations From a National Institute of Neurological Disorders and Stroke Workgroup. Neurology 2023; 101:S47-S58. [PMID: 37580153 DOI: 10.1212/wnl.0000000000207564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
The national mandate to improve health equity in the United Sates is advancing. Racial and ethnic disparities in various aspects of health care have been clearly delineated, and sources of such disparities have been identified. However, implementing solution-focused interventions to eradicate such disparities, thereby achieving health equity in all US communities, has remained a daunting challenge, and no area more so, than with neurologic diseases. To assure success with bridging prominent disparities in neurologic outcomes, the pipeline of neurologic disparities researchers needs to be broadened, numbers of mid-career and senior disparities scientists sustained, partnerships with community stakeholders enhanced, incentivization of academic organizations pursued, education of all neurologic researchers conducted, and exemplary training of funding agency staff prioritized. To improve the current state of neurologic disparities, the National Institute of Neurological Disorders and Stroke assembled a working group of its advisory council. (2020-2022) to examine the state of health disparity training and research. Through consensus building, we present identified gaps and recommendations to the current state of underrepresented groups in medicine in health disparity research and its training and curricula in the United States.
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Affiliation(s)
- Bruce Ovbiagele
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC.
| | - Lilyana Amezcua
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Salvador Cruz Cruz-Flores
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Patrick Griffith
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Girardin Jean-Louis
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Carolyn Jenkins
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Virginia J Howard
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Goldie Smith-Byrd
- From the Department of Neurology (B.O.), University of California, San Francisco; Department of Neurology (L.A.), Keck School of Medicine of the University of Southern California, Los Angeles; Department of Neurology (S.C.C.-F.), Texas Tech University Health Sciences Center, Lubbock; Department of Neurology and Neurotherapeutics (P.G.), University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry and Behavioral Science (G.J.-L.), University of Miami Miller School of Medicine, FL; College of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; and Department of Public Health Sciences (G.S.-B.), Wake Forest School of Medicine, Winston-Salem, NC
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Yen IH, Bennett A, Allen S, Vable A, Long DL, Brooks M, Ream RK, Crowe M, Howard VJ. Childhood Residential Mobility and Mental and Physical Health in Later Life: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. J Appl Gerontol 2023; 42:1859-1866. [PMID: 37013813 PMCID: PMC10394967 DOI: 10.1177/07334648231163053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = -0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = -0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people (p = 0.06), those with low childhood SES compared to high childhood SES (p = 0.02), and high ACEs compared to low ACEs (p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.
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Affiliation(s)
- Irene H. Yen
- Public Health Department, University of California, Merced, CA, USA
| | - Aleena Bennett
- School of Public Health, Ryals Public Health Building University of Alabama, Birmingham, AL, USA
| | - Shauntice Allen
- School of Public Health, Ryals Public Health Building University of Alabama, Birmingham, AL, USA
| | - Anusha Vable
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - D. Leann Long
- School of Public Health, Ryals Public Health Building University of Alabama, Birmingham, AL, USA
| | - Marquita Brooks
- School of Public Health, Ryals Public Health Building University of Alabama, Birmingham, AL, USA
| | - Robert K. Ream
- School of Education, Sproul Hall, University of California, Riverside, CA, USA
| | - Michael Crowe
- School of Public Health, Ryals Public Health Building University of Alabama, Birmingham, AL, USA
| | - Virginia J. Howard
- School of Public Health, Ryals Public Health Building University of Alabama, Birmingham, AL, USA
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20
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Lin C, Howard VJ, Nanavati HD, Judd SE, Howard G. The association of baseline depressive symptoms and stress on withdrawal in a national longitudinal cohort: the REGARDS study. Ann Epidemiol 2023; 84:8-15. [PMID: 37182817 PMCID: PMC10524111 DOI: 10.1016/j.annepidem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To measure the association of baseline psychological symptoms (depressive symptoms and perceived stress) with withdrawal from a cohort study. METHODS Depressive symptoms and perceived stress were obtained using validated measures during the baseline computer-assisted telephonic interview for the REasons for Geographic and Racial Differences in Stroke study a national longitudinal cohort (≥45 years, 42% Black, 55% women) recruited between 2003 and 2007. Participants who completed follow-up after September 1, 2019, were considered active. Primary outcome was time to study withdrawal. The association of psychological symptoms and time-to-withdrawal was measured using Cox proportional hazard regression models with incremental adjustments by demographic and clinical factors. RESULTS Out of 29,964 participants included in the analysis, 11,111 (37.1%) participants withdrew over the follow-up period (median: 11 years). Compared to participants with low depressive symptoms, those with moderate symptoms had 5% higher risk (aHR= 1.05; 95% CI= 1.00-1.10) and those with high level of depressive had 19% higher risk (aHR= 1.19; 95% CI= 1.11-1.27) of withdrawal in fully adjusted models. No significant association between perceived stress and withdrawal risk was observed. CONCLUSIONS Depressive symptoms were significantly associated with withdrawal. Prevalence of depressive symptoms at baseline is an important indicator of participant retention in large prospective cohorts.
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Affiliation(s)
- Chen Lin
- Department of Neurology, University of Alabama at Birmingham, Birmingham.
| | - Virginia J Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Hely D Nanavati
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
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21
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Ruhl AP, Jeffries N, Yang Y, Brooks SD, Naik RP, Pecker LH, Mott BT, Winkler CA, Armstrong ND, Zakai NA, Gutierrez OM, Judd SE, Howard VJ, Howard G, Irvin MR, Cushman M, Ackerman HC. Alpha globin gene copy number and incident ischemic stroke risk among Black Americans. Front Stroke 2023; 2:1192465. [PMID: 37622047 PMCID: PMC10448705 DOI: 10.3389/fstro.2023.1192465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Introduction People with African ancestry have greater stroke risk and greater heritability of stroke risk than people of other ancestries. Given the importance of nitric oxide (NO) in stroke, and recent evidence that alpha globin restricts nitric oxide release from vascular endothelial cells, we hypothesized that alpha globin gene (HBA) deletion would be associated with reduced risk of incident ischemic stroke. Methods We evaluated 8,947 participants self-reporting African ancestry in the national, prospective Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Incident ischemic stroke was defined as non-hemorrhagic stroke with focal neurological deficit lasting ≥ 24 hours confirmed by the medical record or focal or non-focal neurological deficit with positive imaging confirmed with medical records. Genomic DNA was analyzed using droplet digital PCR to determine HBA copy number. Multivariable Cox proportional hazards regression was used to estimate the hazard ratio (HR) of HBA copy number on time to first ischemic stroke. Results Four-hundred seventy-nine (5.3%) participants had an incident ischemic stroke over a median (IQR) of 11.0 (5.7, 14.0) years' follow-up. HBA copy number ranged from 2 to 6: 368 (4%) -α/-α, 2,480 (28%) -α/αα, 6,014 (67%) αα/αα, 83 (1%) ααα/αα and 2 (<1%) ααα/ααα. The adjusted HR of ischemic stroke with HBA copy number was 1.04; 95%CI 0.89, 1.21; p = 0.66. Conclusions Although a reduction in HBA copy number is expected to increase endothelial nitric oxide signaling in the human vascular endothelium, HBA copy number was not associated with incident ischemic stroke in this large cohort of Black Americans.
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Affiliation(s)
- A. Parker Ruhl
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Pulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Neal Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Yu Yang
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Rockville, Maryland
| | - Steven D. Brooks
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan T. Mott
- Wake Forest University School of Medicine, Winston-Salem, North Carolina:
| | - Cheryl A. Winkler
- Basic Research Laboratory, National Cancer Institute, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Nicole D. Armstrong
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Orlando M. Gutierrez
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E. Judd
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Hans C. Ackerman
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Short SAP, Wilkinson K, Schulte J, Renteria MA, Cheung KL, Nicoli CD, Howard VJ, Cushman M. Plasma Pro-Enkephalin A and Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke Cohort. J Am Heart Assoc 2023:e029081. [PMID: 37260023 PMCID: PMC10381999 DOI: 10.1161/jaha.122.029081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Cardiovascular disease is a risk factor for cognitive impairment. Evidence links both lower and higher concentration of the circulating opioid pro-enkephalin A (PENK-A) with stroke risk. We studied the association of plasma PENK-A with incident cognitive impairment. Methods and Results REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a prospective cohort study of 30 239 adults enrolled from 2003 to 2007. Baseline PENK-A was measured in a nested case-control study of 462 participants who developed cognitive impairment over 4.7 years, and 556 controls. Logistic regression and spline plots adjusted for confounders estimated odds ratios (ORs) of cognitive impairment by baseline PENK-A. Interaction terms tested for differences in associations by age, sex, and race. Baseline PENK-A was comparable between cases and controls. There were significant differences in the association of PENK-A with cognitive impairment by sex and age (adjusted P=0.003 and 0.06, respectively). In women but not men, spline plots showed that higher and lower PENK-A were associated with decreased odds of cognitive impairment (ORs for 10th and 90th percentiles versus median, 0.65 [95% CI, 0.43-0.96] and 0.64 [95% CI, 0.41-0.99]), with no difference by age. In men ≥65 years of age but not younger men, higher PENK-A was associated with decreased odds for cognitive impairment (OR for fourth versus first quartile 0.47 [95% CI, 0.22-0.99]); this pattern was not confirmed with spline plotting. Conclusions High and low levels of circulating opioid PENK-A were associated with decreased odds of future cognitive impairment in specific subgroups. Additional research is warranted to understand the biology underlying this association and the observed differences by sex.
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Affiliation(s)
- Samuel A P Short
- Larner College of Medicine University of Vermont Burlington VT USA
| | - Katherine Wilkinson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont Burlington VT USA
| | | | - Miguel Arce Renteria
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology Columbia University College of Physicians and Surgeons New York NY USA
| | - Katharine L Cheung
- Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont Burlington VT USA
- Department of Medicine, Larner College of Medicine University of Vermont Burlington VT USA
| | - Charles D Nicoli
- Department of Medicine Walter Reed National Military Medical Center Bethesda MD USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health University of Alabama at Birmingham Birmingham AL USA
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont Burlington VT USA
- Department of Medicine, Larner College of Medicine University of Vermont Burlington VT USA
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Ruhl AP, Jeffries N, Yang Y, Brooks SD, Naik RP, Pecker LH, Mott BT, Winkler CA, Armstrong ND, Zakai NA, Gutierrez OM, Judd SE, Howard VJ, Howard G, Irvin MR, Cushman M, Ackerman HC. Alpha globin gene copy number and incident ischemic stroke risk among Black Americans. medRxiv 2023:2023.03.15.23286908. [PMID: 36993674 PMCID: PMC10055557 DOI: 10.1101/2023.03.15.23286908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction People with African ancestry have greater stroke risk and greater heritability of stroke risk than people of other ancestries. Given the importance of nitric oxide (NO) in stroke, and recent evidence that alpha globin restricts nitric oxide release from vascular endothelial cells, we hypothesized that alpha globin gene ( HBA) deletion would be associated with reduced risk of incident ischemic stroke. Methods We evaluated 8,947 participants self-reporting African ancestry in the national, prospective Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Incident ischemic stroke was defined as non-hemorrhagic stroke with focal neurological deficit lasting ≥ 24 hours confirmed by the medical record or focal or non-focal neurological deficit with positive imaging confirmed with medical records. Genomic DNA was analyzed using droplet digital PCR to determine HBA copy number. Multivariable Cox proportional hazards regression was used to estimate the hazard ratio (HR) of HBA copy number on time to first ischemic stroke. Results Four-hundred seventy-nine (5.3%) participants had an incident ischemic stroke over a median (IQR) of 11.0 (5.7, 14.0) years' follow-up. HBA copy number ranged from 2 to 6: 368 (4%) -α/-α, 2,480 (28%) -α/αα, 6,014 (67%) αα/αα, 83 (1%) ααα/αα and 2 (<1%) ααα/ααα. The adjusted HR of ischemic stroke with HBA copy number was 1.04; 95%CI 0.89, 1.21; p = 0.66. Conclusions Although a reduction in HBA copy number is expected to increase endothelial nitric oxide signaling in the human vascular endothelium, HBA copy number was not associated with incident ischemic stroke in this large cohort of Black Americans.
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Affiliation(s)
- A. Parker Ruhl
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Pulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Neal Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Yu Yang
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Rockville, Maryland
| | - Steven D. Brooks
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan T. Mott
- Wake Forest University School of Medicine, Winston-Salem, North Carolina:
| | - Cheryl A. Winkler
- Basic Research Laboratory, National Cancer Institute, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Nicole D. Armstrong
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Orlando M. Gutierrez
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E. Judd
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Hans C. Ackerman
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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24
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Harris ML, Bennion E, Magnusson KR, Howard VJ, Wadley VG, McClure LA, Levine DA, Manly JJ, Avila JF, Glymour MM, Wisco JJ, Thacker EL. Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment. Neuroepidemiology 2023; 57:218-228. [PMID: 37231876 DOI: 10.1159/000530961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/02/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Rural versus urban living is a social determinant of cognitive health. We estimated the association of rural versus urban residence in the USA with incident cognitive impairment (ICI) and assessed effect heterogeneity by sociodemographic, behavioral, and clinical factors. METHODS The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) is a population-based prospective observational cohort of 30,239 adults, 57% female, 36% Black, aged 45+ years, sampled from 48 contiguous states in the USA in 2003-2007. We analyzed 20,878 participants who at baseline were cognitively intact with no history of stroke and had ICI assessed on average 9.4 years later. We classified participants' home addresses at baseline as urban (population ≥50,000), large rural (10,000-49,999), or small rural (≤9,999) by Rural-Urban Commuting Area codes. We defined ICI as ≥1.5 SD below the mean on at least 2 of the following tests: word list learning, word list delayed recall, and animal naming. RESULTS Participants' home addresses were 79.8% urban, 11.7% large rural, and 8.5% small rural. ICI occurred in 1,658 participants (7.9%). Small rural residents had higher odds of ICI than urban residents, adjusted for age, sex, race, region, and education (OR = 1.34 [95% CI: 1.10, 1.64]), and after further adjustment for income, health behaviors, and clinical characteristics (OR = 1.24 [95% CI: 1.02, 1.53]). Former smoking versus never, nondrinking versus light alcohol drinking, no exercise versus ≥4 times/week, CES-D depressive symptom score of 2 versus 0, and fair versus excellent self-rated health had stronger associations with ICI in small rural areas than in urban areas. For example, in urban areas, lack of exercise was not associated with ICI (OR = 0.90 [95% CI: 0.77, 1.06]); however, lack of exercise combined with small rural residence was associated with 1.45 times the odds of ICI compared with ≥4 bouts of exercise/week in urban areas (95% CI: 1.03, 2.03). Overall, large rural residence was not associated with ICI; however, black race, hypertension, and depressive symptoms had somewhat weaker associations with ICI, and heavy alcohol drinking a stronger association with ICI, in large rural areas than in urban areas. CONCLUSION Small rural residence was associated with ICI among USA adults. Further research to better understand why rural residents are at higher risk for developing ICI and mechanisms to ameliorate that risk will support efforts to advance rural public health.
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Affiliation(s)
- Matthew L Harris
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- University at Buffalo Jacobs School of Medicine, State University of New York, Buffalo, New York, USA
| | - Erica Bennion
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristine R Magnusson
- Department of Public Health, Brigham Young University, Provo, Utah, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer J Manly
- Department of Neurology, Columbia University, New York, New York, USA
| | - Justina F Avila
- Department of Neurology, Columbia University, New York, New York, USA
| | - Maria M Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jonathan J Wisco
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Evan L Thacker
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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25
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Levine DA, Chen B, Galecki AT, Gross AL, Briceño EM, Whitney RT, Ploutz-Snyder RJ, Giordani BJ, Sussman JB, Burke JF, Lazar RM, Howard VJ, Aparicio HJ, Beiser AS, Elkind MSV, Gottesman RF, Koton S, Pendlebury ST, Sharma A, Springer MV, Seshadri S, Romero JR, Hayward RA. Associations Between Vascular Risk Factor Levels and Cognitive Decline Among Stroke Survivors. JAMA Netw Open 2023; 6:e2313879. [PMID: 37195662 PMCID: PMC10193182 DOI: 10.1001/jamanetworkopen.2023.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/30/2023] [Indexed: 05/18/2023] Open
Abstract
Importance Incident stroke is associated with accelerated cognitive decline. Whether poststroke vascular risk factor levels are associated with faster cognitive decline is uncertain. Objective To evaluate associations of poststroke systolic blood pressure (SBP), glucose, and low-density lipoprotein (LDL) cholesterol levels with cognitive decline. Design, Setting, and Participants Individual participant data meta-analysis of 4 US cohort studies (conducted 1971-2019). Linear mixed-effects models estimated changes in cognition after incident stroke. Median (IQR) follow-up was 4.7 (2.6-7.9) years. Analysis began August 2021 and was completed March 2023. Exposures Time-dependent cumulative mean poststroke SBP, glucose, and LDL cholesterol levels. Main Outcomes and Measures The primary outcome was change in global cognition. Secondary outcomes were change in executive function and memory. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition. Results A total of 1120 eligible dementia-free individuals with incident stroke were identified; 982 (87.7%) had available covariate data and 138 (12.3%) were excluded for missing covariate data. Of the 982, 480 (48.9%) were female individuals, and 289 (29.4%) were Black individuals. The median age at incident stroke was 74.6 (IQR, 69.1-79.8; range, 44.1-96.4) years. Cumulative mean poststroke SBP and LDL cholesterol levels were not associated with any cognitive outcome. However, after accounting for cumulative mean poststroke SBP and LDL cholesterol levels, higher cumulative mean poststroke glucose level was associated with faster decline in global cognition (-0.04 points/y faster per each 10-mg/dL increase [95% CI, -0.08 to -0.001 points/y]; P = .046) but not executive function or memory. After restricting to 798 participants with apolipoprotein E4 (APOE4) data and controlling for APOE4 and APOE4 × time, higher cumulative mean poststroke glucose level was associated with a faster decline in global cognition in models without and with adjustment for cumulative mean poststroke SBP and LDL cholesterol levels (-0.05 points/y faster per 10-mg/dL increase [95% CI, -0.09 to -0.01 points/y]; P = .01; -0.07 points/y faster per 10-mg/dL increase [95% CI, -0.11 to -0.03 points/y]; P = .002) but not executive function or memory declines. Conclusions and Relevance In this cohort study, higher poststroke glucose levels were associated with faster global cognitive decline. We found no evidence that poststroke LDL cholesterol and SBP levels were associated with cognitive decline.
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Affiliation(s)
- Deborah A. Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Bingxin Chen
- Department of Nursing, University of Michigan, Ann Arbor
| | - Andrzej T. Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, Maryland
| | - Emily M. Briceño
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Rachael T. Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | | | - Bruno J. Giordani
- Department of Psychiatry and Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor
| | - Jeremy B. Sussman
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - James F. Burke
- Department of Neurology, Ohio State University College of Medicine, Columbus
| | - Ronald M. Lazar
- Department of Neurology and Evelyn F. McKnight Brain Institute, Heersink School of Medicine, University of Alabama at Birmingham
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health
| | - Hugo J. Aparicio
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
| | - Alexa S. Beiser
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, Maryland
- Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Sarah T. Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Departments of Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Anu Sharma
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Mellanie V. Springer
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Sudha Seshadri
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
- Department of Neurology and Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, Joe R. and Teresa Lozano Long School of Medicine, University of Texas San Antonio
| | - Jose R. Romero
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts
| | - Rodney A. Hayward
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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26
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Howard G, Banach M, Kissela B, Cushman M, Muntner P, Judd SE, Howard VJ. Age-Related Differences in the Role of Risk Factors for Ischemic Stroke. Neurology 2023; 100:e1444-e1453. [PMID: 36653179 PMCID: PMC10104611 DOI: 10.1212/wnl.0000000000206837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/06/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Reports assessing the association of stroke risk factors with incident stroke have generally assumed a uniform magnitude of associations across the age spectrum, an assumption we assess in this report. METHODS Participants enrolled 2003-2007 in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study who were stroke free at baseline were followed for incident stroke. Associations of traditional stroke risk factors with incident stroke were assessed using (1) proportional hazards analysis based on the baseline age of the participant and (2) Poisson regression analysis assessing associations based on the changing age of the participant during their follow-up (age at exposure). In each analysis, age strata were selected to have a similar number of strokes in each stratum, specifically 45-64, 65-73, and 74+ years for the proportional hazards analysis and 45-69, 70-79, and 80+ years for Poisson regression. RESULTS A total of 1,405 ischemic stroke events occurred among 28,235 participants over a median follow-up of 11.3 years, with a total of 276,074 person-years exposure. For both analytic approaches, the magnitude of the association with stroke was significantly less at older ages for diabetes (hazard or relative risk decreasing from ≈2.0 in younger strata to ≈1.3 in older strata), heart disease (from ≈2.0 to ≈1.3), and hypertension defined at a threshold of 140/90 mm Hg (from ≈1.80 to ≈1.50); however, there was no age-related difference in the magnitude of the association for smoking, atrial fibrillation, or left ventricular hypertrophy. DISCUSSION Hypertension and diabetes are 2 of the more important risk factors for stroke; however, their association with stroke risk appears substantially less at older ages. That the magnitude of the association for smoking, atrial fibrillation, and left ventricular hypertrophy does not decrease with age suggests their relative importance in determining stroke risk likely increases with age.
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Affiliation(s)
- George Howard
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL.
| | - Maciej Banach
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Brett Kissela
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Mary Cushman
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Paul Muntner
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Suzanne E Judd
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL
| | - Virginia J Howard
- From the Department of Biostatistics (G.H., S.E.J.), UAB School of Public Health, Birmingham, AL; Polish Mother Memorial Hospital Research Institute (M.B.), Lodz, Poland; Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, OH; Department of Medicine (M.C.), University of Vermont, Burlington, VT; and Department of Epidemiology (P.M., V.J.H.), UAB School of Public Health, Birmingham, AL.
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27
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Brott TG, Meschia JF, Lal BK, Chamorro Á, Howard VJ, Howard G. When Will We Have What We Need to Advise Patients How to Manage Their Carotid Stenosis?: Lessons From SPACE-2. Stroke 2023; 54:1452-1456. [PMID: 36942589 PMCID: PMC10133171 DOI: 10.1161/strokeaha.122.042172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The recently published SPACE-2 trial (Stent-Supported Percutaneous Angioplasty of the Carotid Artery Versus Endarterectomy-2) compared 3 treatments to prevent stroke in patients with asymptomatic carotid stenosis ≥70%: (1) carotid endarterectomy plus best medical treatment (BMT), (2) transfemoral carotid artery stenting plus BMT, or (3) BMT alone. Because of low enrollment, the findings of similar safety and efficacy for carotid endarterectomy, carotid artery stenting, or BMT alone were inconclusive. Publication of the CREST (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial)-2 results should provide level A evidence that has been lacking for 2 to 3 decades, to guide treatment of asymptomatic patients with severe carotid stenosis. For symptomatic patients with ≥70% stenosis, no trials are underway to update the degree of benefit reported for carotid endarterectomy by NASCET (North American Carotid Endarterectomy Trial) and ECST (European Carotid Surgery Trial), published in 1991. Subsequently, the use of cigarettes has plummeted, and major improvements in medical treatments and in carotid revascularization have emerged. These advances have coincided with abrupt decline in the clinical end points necessary for treatment comparisons in procedural trials. One of the advances in the invasive management of carotid disease has been transcarotid artery revascularization, already with limited approval by the US Food and Drug Administration. Establishing safety and efficacy of transcarotid artery revascularization compared with carotid endarterectomy, carotid artery stenting, or BMT alone may be challenging because of enrollment, regulatory, and funding barriers to design and complete an adequately powered randomized trial.
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Affiliation(s)
- Thomas G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.)
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.)
| | - Brajesh K Lal
- Department of Surgery, University of Maryland, Baltimore (B.K.L.)
| | - Ángel Chamorro
- Department of Neurology, Hospital Clinic, Barcelona, Spain (A.C.)
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham. (V.J.H.)
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham. (G.H.)
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28
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Kim JS, Sun Y, Balte P, Cushman M, Tracy RP, Styer L, Anderson MR, Allen NB, Schreiner P, Bowler RP, Schwartz D, Lee J, Xanthakis V, Doyle M, Kanaya AM, Elkind MS, Howard VJ, Ortega V, Woodruff P, Cole S, Mantis N, Parker M, Barr RG, Oelsner E, Demmer R. Abstract P540: Cardiovascular Disease Risk Factors and Antibody Response to COVID-19 Vaccination: The C4R Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:
Adults with cardiovascular co-morbidities and risk factors are at greater risk of severe COVID-19. These same risk factors may also be associated with an attenuated antibody response to COVID-19 vaccines, although studies in diverse, U.S. population-based cohorts have been limited.
Methods:
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) conducted a serosurvey for SARS-CoV-2 antibodies via dried blood spot (DBS) in 14 U.S. cohorts. IgG antibodies to SARS-CoV-2 spike subunit 1 (S1) and nucleocapsid (N) were measured from DBS using a semi-quantitative microsphere immunoassay and reported as median fluorescence intensity (MFI). Multivariable adjusted linear models regressed log-transformed anti-S1 MFI on age, sex, race/ethnicity, education attainment, self-reported diabetes, hypertension, cardiovascular disease (CVD), chronic kidney disease, smoking history, body mass index (BMI), asthma, obstructive lung diseases, DBS batch, anti-N MFI, vaccine type, time between vaccine and DBS, and vaccine dose at time of DBS collection. Results are presented as the percent difference in anti-S1 MFI compared with a reference group.
Results:
There were 6614 vaccinated participants prior to booster regimens and DBS collection (April 2021-July 2022) with 50%, 48%, and 2% of the cohort who received BNT162b2, mRNA-1273, or other vaccines, respectively. The mean (SD) time between vaccination and DBS was 3.8 (1.8) months. Over 10% of the cohort had self-reported a history of diabetes, 55% had hypertension, and 74% had a BMI>25 kg/m
2
. Anti-S1 MFI decreased as the time between vaccine dose and DBS collection increased. Diabetes was associated with a 16.1% lower anti-S1 MFI (95%CI:-22.4,-9.5) whereas neither hypertension (-3.8%;95%CI:-9.3,2.1), nor cardiovascular disease history (-5.3%;95%CI:-16.3,7.4) were associated with anti-S1 MFI. Former and current smoking history were each associated with a lower anti-S1 MFI: (-6.6%;95%CI:-12.1,-0.8) and (-16.1%;95%CI:-24.7,-6.6), respectively. Participants with a BMI 25-29.9 kg/m
2
had a 7.6% higher anti-S1 MFI (95%CI:0.3,15.4) whereas those with a BMI of 30-35 kg/m
2
and >35 kg/m
2
had 6.2% (95%CI:-2.4,15.5) higher and 8.9% lower (95%CI:-17.6,0.7) MFI levels, respectively. Older age and male sex were each associated with a lower anti-S1 MFI and mRNA-1273 vaccine, Asian subgroup, higher anti-N titer, and prior COVID-19 infection were each associated with higher anti-S1 MFI. Chronic kidney disease, education attainment, and lung disease were not associated with anti-S1 MFI.
Conclusions:
Several traditional cardiovascular disease risk factors were associated with diminished humoral responses to the initial COVID-19 vaccine regimens in a diverse U.S. population-based cohort and may have implications on strategies to improve vaccine responses.
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Affiliation(s)
| | | | | | | | | | - Linda Styer
- New York State Dept of Health Wadsworth Cntr, Albany, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shelley Cole
- Texas Biomedical Rsch Institute, San Antonio, TX
| | | | - Monica Parker
- New York State Dept of Health Wadsworth Cntr, Albany, NY
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29
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Stoutenburg E, Sherman S, Bravo MC, Howard VJ, Kamin Mukaz D, Cushman M, Zakai N, Judd SE, Plante TB. Abstract P381: Factor VIII and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:
Black adults have a disproportionate hypertension burden. While some excess risk is mediated by diet and sociodemographics factors (e.g., income, education) much remains unexplained. Pro-thrombotic and pro-inflammatory states are associated with hypertension risk; higher coagulation factor VIII (FVIII) is associated with thrombosis, inflammation, and cardiovascular disease. Black adults have higher FVIII than White adults. We sought to estimate incident hypertension risk among Black and White REGARDS adults by FVIII level, and determine if FVIII mediates some of the excess hypertension burden in Black REGARDS participants.
Methods:
Hypertension was use of blood pressure (BP)-lowering medications or 140/90 mm Hg BP threshold. We included Black and White participants from REGARDS without Visit 1 (2003-2007) hypertension, and hypertension assessment at visit 2 (2013-2016), and Visit 1 ELISA-measured FVIII. Modified Poisson regression estimated risk ratios (RR) of incident hypertension by FVIII level in models controlling for known confounders, stratified by race given a significant race*FVIII interaction on incident hypertension. Inverse odds ratio weighting estimated % mediation of the Black-White hypertension risk in each model that was due to FVIII.
Results:
Among the 1,870 included participants, mean (SD) age was 62 (8), 51% were female and 36% were Black participants. Relative to White participants, Black participants had higher mean FVIII level (114% vs. 103%; P<0.001) and 46% greater hypertension risk (95% CI 30-65%) in the crude model. Higher FVIII did not associate with greater hypertension risk in any model (
Figure
). Factor VIII did not mediate excess burden of hypertension among Black participants in any models.
Conclusions:
FVIII was not associated with greater hypertension risk and did not mediate any of the excess burden of incident hypertension seen among Black participants.
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Balte P, Sun Y, Sharaf A, Krishnaswamy A, Arynchyn A, Regan EA, Ramachandran VS, Schwartz D, Post WS, Kanaya AM, Elkind M, Howard VJ, Ortega V, Woodruff P, Cole S, Oelsner EC. Abstract P461: Changes in Cigarette Smoking Patterns During the COVID-19 Pandemic: The C4R Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Rationale:
The impact of the COVID-19 pandemic on tobacco use patterns remains incompletely understood. We aimed to examine changes in cigarette smoking patterns over the first 2 years of the COVID-19 pandemic (2020-22) in a large, multiethnic, US community-based sample.
Methods:
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) ascertained the impact of the COVID-19 pandemic on participants from 14 longitudinal NIH-funded cohorts via 2 waves of standardized questionnaires conducted 2020-22. The C4R questionnaire collected data on cigarette use patterns for the current and immediate pre-pandemic periods (January-March 2020). These data were used to define pandemic-era smoking initiation, smoking cessation, and changes in smoking intensity. Multivariable logistic regression models were adjusted for centrally harmonized pre-pandemic data on sociodemographic characteristics, remote smoking history, and co-morbidities and pandemic-era psychological health, insomnia, and SARS-CoV-2 infection history ascertained through C4R questionnaires. Multiple imputation by chained equations was used to account for missing covariate data.
Results:
Of 17179 participants completing C4R questions on pandemic-era smoking behaviors, 1899 (11%) participants reported current smoking in the immediate pre-pandemic period (mean age 70 years, 59% women, 31% African American, 2% Hispanic, 1% Asian, 22% American Indian/Alaskan Native [AIAN]). Of these 181 (10%) self-reported quitting during the pandemic. Among 1718 (90%) who continued smoking, smoking intensity increased in 17% and decreased in 26%. Among 15093 participants who were not smoking prior to March 2020, 135 (0.9%) initiated smoking during the pandemic period, including 120 (89%) with a remote history of smoking and 15 (11%) with no history of smoking. Pandemic-era smoking cessation was associated with older age(80+ years vs <65 years [adjusted odds ratio; 95%CI] 2.1; 1.1-4.0), obesity(vs normal weight 1.6; 1.02-2.6) and history of SARS-CoV-2 infection (2.1; 1.3-3.1). Pandemic-era smoking initiation was associated with concurrent use of cannabis (3.1; 1.9-5.2), e-cigarette (29.6; 14.8-59.2), and/or alcohol (1.8; 1.1-2.9). Compared to non-Hispanic white participants, AIAN participants had lower odds of quitting (0.1; 0.03-0.6) and African American participants had higher odds of increased smoking intensity (2.0; 1.3-3.1). Depressive symptoms were associated with smoking initiation (2.4; 1.3-4.3) and increased smoking intensity (2.6; 1.5-4.5).
Conclusion:
Greater odds of smoking initiation and/or increased smoking intensity were observed in minoritized groups and participants reporting depressive symptoms. Majority of those who initiated smoking during pandemic-era were relapsers. Smoking cessation programs remain important to improving public health and reducing health disparities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shelley Cole
- Texas Biomedical Rsch Institute, San Antonio, TX
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Kamin Mukaz D, Sparks A, Plante TB, Judd SE, Howard G, Howard VJ, Carson AP, Dean L, Dougherty G, Cushman M. Abstract P150: Residential Segregation and Hypertension Risk in Black and White Americans. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
Black adults experience the highest hypertension burden of any American group. Evidence indicates social factors adversely affecting Black people explain some of the excess hypertension burden. It’s unclear whether residential segregation, a key cause of health inequities, has a differential impact on Black and White people.
Hypothesis:
The magnitude of the association of residential segregation and risk of incident hypertension will be greater in Black than White people.
Methods:
Our sample included 6,143 Black and White REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants without prevalent hypertension (2003-7), and with a follow-up visit 9.3 years later. Baseline county-level segregation was measured with the (1) dissimilarity index (DI, the difference in race distribution of census tracts relative to their county), (2) isolation index (ISI, the degree to which Black people are exposed only to one another in a county), and (3) interaction index (ITI, the degree to which Black people are exposed to White people in a county). Modified Poisson regression estimated the risk ratios (RR) of incident hypertension per SD increment of baseline residential segregation.
Results:
The mean (SD) age was 61(8) years for Black people and 62(8) years for White people. Hypertension incidence was 46% for Black people and 33% for White people. There was no
association of any of the three measures of residential segregation (DI, ISI and ITI) with incident hypertension, with RRs all around 1.0 (
Figure
).
Conclusions:
Three measures of residential segregation were not associated with incident hypertension risk in Black and White participants of the REGARDS cohort. Findings differ from a previous study that reported that a measure of racial clustering was associated with higher risk of hypertension in Black people. Taken together, findings suggest that, in Black people, different domains of residential segregation capture factors related differently to hypertension development.
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Kraal AZ, Ramirez E, Gavarrete Olvera A, Balte P, Briceno EM, Demmer RT, Elkind MS, González HM, Gross AL, Heckbert SR, Howard VJ, Krishnaswamy A, Levine DA, Mosley TH, Oelsner EC, Seshadri S, Suchy-Dicey A, Yaffe K, Manly JJ, Palta P. Abstract P507: Pre-Statistical Harmonization of Cognitive Measures Across Eight Population-Based NIH Cohorts in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R). Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Long-term neurological consequences (eg, stroke, impaired cognition) have been linked to SARS-CoV-2 infection and severity. There are limited data from studies with racial, ethnic, socioeconomic, and geographic diversity. C4R is a prospective study of adults from 14 cohorts that aims to link pre-COVID phenotyping, including cognition (8 studies), to COVID related illness and sequelae. We aimed to conduct pre-statistical harmonization of cognitive tests administered in English and Spanish from 8 cohorts: ARIC, CARDIA, FHS, HCHS/SOL-INCA, MESA, NOMAS, REGARDS, and SHS (Table).
Methods:
We conducted extensive item-level review of administration, scoring, and coding procedures and score distributions for 84 tests administered in English (all studies) and Spanish (NOMAS, MESA, HCHS/SOL-INCA).
Results:
Orientation to time and 3-word registration and recall spanned all studies and both languages. Word list recall and verbal fluency (animal; letter) spanned 7 studies (Table). There was variability in the structure, content, administration, scoring, and data coding procedures for items across cohorts and between Spanish and English. Word lists varied by number of words (9-16) and learning trials (3-5). Animal naming varied by time (30 vs. 60 seconds), animal type (4-legged vs. any animal), and scoring (allowing mythical/imaginary animals). Letter fluency varied by whether both Spanish and English words were permitted. Other tests differed by version, study-specific adaptations, prompts/cues, and specificity of scoring rules across cohorts.
Conclusions:
Cognitive test harmonization requires detailed review of administration, scoring, coding, translation, and procedural differences. Accounting for this variability is essential to cognitive data interpretation. Our pre-statistical harmonization will inform data augmentation and formal harmonization to yield harmonized measures of cognition to clarify population-level differences in cognitive outcomes linked to SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sudha Seshadri
- Univ of Texas Health Science Cntr at San Antonio, San Antonio, TX
| | | | | | | | - Priya Palta
- Univ of North Carolina at Chapel Hill, Chapel Hill, NC
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Meschia JF, Lal B, Roubin G, Turan TN, Howard VJ, Benson RT, Carman K, Howard G, Brott TG. Adapting to Evolving Technologies and Treatment Guidelines in a Procedural Trial: A Qualitative Review of the CREST-2 Experience. Neurology 2023; 100:1060-1066. [PMID: 36746636 DOI: 10.1212/wnl.0000000000207075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/04/2023] [Indexed: 02/08/2023] Open
Abstract
Multiple challenges confront procedural trials, including slow enrollment, lack of equipoise among patients and physicians, and failure to achieve adequate masking. Nonetheless, randomized clinical trials provide the best evidence of efficacy. The evolution of technology, techniques, and standards of care during the conduct of procedural trials challenges external validity. Herein, we review how a multicenter trial of revascularization of asymptomatic carotid arteries for stroke prevention has managed changes in treating carotid stenosis and medical management of atherothrombotic disease.
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Affiliation(s)
| | - Brajesh Lal
- University of Maryland School of Medicine, Baltimore. Maryland
| | - Gary Roubin
- CREST-2 Executive Committee; Jackson, Wyoming
| | - Tanya N Turan
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Richard T Benson
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | | | - George Howard
- University of Alabama at Birmingham, Birmingham, Alabama
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Elayoubi J, Haley WE, Roth DL, Cushman M, Sheehan OC, Howard VJ, Hladek MD, Hueluer G. Associations of perceived stress, depressive symptoms, and caregiving with inflammation: a longitudinal study. Int Psychogeriatr 2023; 35:95-105. [PMID: 35543307 DOI: 10.1017/s1041610222000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Higher inflammation has been linked to poor physical and mental health outcomes, and mortality, but few studies have rigorously examined whether changes in perceived stress and depressive symptoms are associated with increased inflammation within family caregivers and non-caregivers in a longitudinal design. DESIGN Longitudinal Study. SETTING REasons for Geographic And Racial Differences in Stroke cohort study. PARTICIPANTS Participants included 239 individuals who were not caregivers at baseline but transitioned to providing substantial and sustained caregiving over time. They were initially matched to 241 non-caregiver comparisons on age, sex, race, education, marital status, self-rated health, and history of cardiovascular disease. Blood was drawn at baseline and approximately 9.3 years at follow-up for both groups. MEASUREMENTS Perceived Stress Scale, Center for Epidemiological Studies-Depression, inflammatory biomarkers, including high-sensitivity C-reactive protein, D dimer, tumor necrosis factor alpha receptor 1, interleukin (IL)-2, IL-6, and IL-10 taken at baseline and follow-up. RESULTS Although at follow-up, caregivers showed significantly greater worsening in perceived stress and depressive symptoms compared to non-caregivers, there were few significant associations between depressive symptoms or perceived stress on inflammation for either group. Inflammation, however, was associated with multiple demographic and health variables, including age, race, obesity, and use of medications for hypertension and diabetes for caregivers and non-caregivers. CONCLUSIONS These findings illustrate the complexity of studying the associations between stress, depressive symptoms, and inflammation in older adults, where these associations may depend on demographic, disease, and medication effects. Future studies should examine whether resilience factors may prevent increased inflammation in older caregivers.
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Affiliation(s)
- Joanne Elayoubi
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - Mary Cushman
- Department of Medicine & Pathology, University of Vermont, Burlington, VT, USA
| | - Orla C Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gizem Hueluer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Hart S, Howard VJ, Cummings DM, Albright KC, Howard G. Abstract WMP42: Differences In Antihypertensive Prescribing And Smoking Cessation Counseling After Acute Ischemic Stroke 2003-2016: The National Regards Cohort Study. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Limited population-based evidence is available about risk factor management following stroke. We examined age, race, sex, and regional (Stroke Belt vs. other) differences in discharge antihypertensive prescribing and smoking cessation counseling after ischemic stroke using population level data from a national cohort study.
Methods:
Medical record data was abstracted from 1042 participants enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had an adjudicated ischemic stroke between 2003-2016. Participants with a history of prior stroke, in-hospital death, hospice discharge, incomplete records, and non-smokers for smoking cessation analyses were excluded resulting in 798 cases for discharge antihypertensive prescribing and 117 cases for smoking cessation counseling in the final analyses. Differences were assessed using modified Poisson regression adjusting for patient and hospital level factors.
Results:
Overall, 86% received discharge antihypertensives while 50% of current smokers received counseling at discharge. Participants who were older, female, had a greater number of CV risk factors, and higher BMIs were significantly more likely to receive discharge antihypertensives compared to younger participants, males, those with fewer risk factors and lower BMIs, respectively (age RR 1.05; 95% CI, 1.02-1.09; female sex RR 1.09; 95% CI, 1.03-1.16; total risk factors RR 1.07; 95% CI, 1.04-1.10; BMI RR 1.01; 95% CI, 1.00-1.01). There was an increasing trend in receipt of smoking cessation counseling over time (RR 1.12; 95% CI, 1.04-1.21).
Conclusions:
Discharge antihypertensive prescribing varies modestly by patient-level variables. There were no differences in smoking cessation counseling by age, sex, race, or study region. Smoking cessation counseling has improved over time, yet only half of smokers received cessation counseling.
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Huynh TB, McClure LA, Howard VJ, Stafford MM, Judd SE, Burstyn I. Duration of employment within occupations and incident stroke in a US general population cohort 45 years of age or older (REGARDS study). Am J Ind Med 2023; 66:142-154. [PMID: 36440885 DOI: 10.1002/ajim.23446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The work environment can contribute to the risk of cardiovascular diseases (CVD) including stroke. Our objective was to identify occupations with elevated risk of stroke within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. METHODS We analyzed incident stroke outcomes (ischemic and hemorrhagic strokes) from 2003 to 2020 and employment characteristics of 13,659 adults aged ≥45 years enrolled in a national population-based cohort study. Using a modified Poisson regression approach, we estimated the relative risks (RRs) and the associated 95% confidence intervals (CI) of stroke in relation to years of employment within each occupation coded using the US Census two-digit Standard Occupation Code. Models were adjusted for Framingham Stroke Risk Score, region, race, age, and body mass index. We conducted stratified analysis by sex, employment time period (pre-1975 vs. post-1975), and region. RESULTS Workers in the following occupations had a greater risk of stroke with longer duration of employment (per decade): protective service (RR: 2.35, 95% CI: 1.11, 4.97), food preparation and service (RR: 1.51, 95% CI: 1.05, 2.19), and transportation and material moving (RR: 1.30, 95% CI: 1.00, 1.69). The stroke risk in these occupations was disproportionately elevated in men, and differed by region and employment time period. CONCLUSIONS Longer employment in protective service, food preparation and serving, and transportation and materials moving occupations may increase the risk of stroke. Surveillance may uncover specific work-related risk factors in these occupations, leading to interventions to reduce the burden of stroke among US workers.
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Affiliation(s)
- Tran B Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Stafford
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Liu C, Marino VR, Howard VJ, Haley WE, Roth DL. Positive aspects of caregiving in incident and long-term caregivers: Role of social engagement and distress. Aging Ment Health 2023; 27:87-93. [PMID: 34749554 PMCID: PMC9126189 DOI: 10.1080/13607863.2021.2000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/17/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress. METHODS Participants included 283 African American or White caregivers from the Caregiving Transitions Study with a wide range of caregiving durations. PAC are defined as positive appraisals that caregivers report about their role, such as feeling appreciated or confident. We fit multivariable linear models with the total PAC score as the outcome to assess its association with years of caregiving and social engagement (social network, monthly social contact). Models were adjusted for age, sex, race, marital status, relationship to care recipient, care recipient's dementia status, perceived stress and caregiving strain. RESULTS Caregivers with higher social engagement reported significantly higher PAC. A non-significant trend was found in most analytic models for caregivers with longer duration of care to report higher PAC. African American caregivers reported higher PAC compared to White caregivers. Dementia caregivers reported lower PAC than non-dementia caregivers in models adjusting for demographics and social network size, but the association was attenuated with the addition of caregiving strain. DISCUSSION Higher social engagement and longer duration of care tend to be associated with higher PAC after adjusting for demographics and measures of distress. Future studies should aim to leverage longitudinal data to understand whether caregivers shift appraisal to positive aspects of their role and explore implementation of caregiving interventions targeting PAC in order to improve the caregiving experience.
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Affiliation(s)
- Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victoria R Marino
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
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Cummings DM, Lutes LD, Wilson JL, Carraway M, Safford MM, Cherrington A, Long DL, Carson AP, Yuan Y, Howard VJ, Howard G. Persistence of Depressive Symptoms and Risk of Incident Cardiovascular Disease With and Without Diabetes: Results from the REGARDS Study. J Gen Intern Med 2022; 37:4080-4087. [PMID: 35230623 PMCID: PMC9708970 DOI: 10.1007/s11606-022-07449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Baseline depressive symptoms are associated with subsequent adverse cardiovascular (CV) events in subjects with and without diabetes but the impact of persistent symptoms vs. improvement remains controversial. OBJECTIVE Examine long-term changes in depressive symptoms in individuals with and without diabetes and the associated risk for adverse CV events. DESIGN REGARDS is a prospective cohort study of CV risk factors in 30,000 participants aged 45 years and older. PARTICIPANTS N = 16,368 (16.5% with diabetes mellitus) who remained in the cohort an average of 11.1 years later and who had complete data. MAIN MEASURES Depressive symptoms were measured using the 4-item Centers for Epidemiologic Study of Depression (CES-D) questionnaire at baseline and again at a mean follow-up of 5.07 (SD = 1.66) years. Adjudicated incident stroke, coronary heart disease (CHD), CV mortality, and a composite outcome were assessed in a subsequent follow-up period of 6.1 (SD = 2.6) years. METHODS The association of changes in depressive symptoms (CES-D scores) across 5 years with incident CV events was assessed using Cox proportional hazards modeling. KEY RESULTS Compared to participants with no depressive symptoms at either time point, participants without diabetes but with persistently elevated depressive symptoms at both baseline and follow-up demonstrated a significantly increased risk of incident stroke (HR (95% CI) = 1.84 (1.03, 3.30)), a pattern which was substantially more prevalent in blacks (HR (95% CI) = 2.64 (1.48, 4.72)) compared to whites (HR (95% CI) = 1.06 (0.50, 2.25)) and in those not taking anti-depressants (HR (95% CI) = 2.01 (1.21, 3.35)) in fully adjusted models. CONCLUSIONS The persistence of depressive symptoms across 5 years of follow-up in participants without diabetes identifies individuals at increased risk for incident stroke. This was particularly evident in black participants and among those not taking anti-depressants.
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Affiliation(s)
- Doyle M Cummings
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.
| | - Lesley D Lutes
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - J Lane Wilson
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Marissa Carraway
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical Center, New York, USA
| | - Andrea Cherrington
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - D Leann Long
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - April P Carson
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Ya Yuan
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia J Howard
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - George Howard
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
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Akinyelure OP, Colantonio LD, Chaudhary NS, Jaeger BC, Judd SE, Cushman M, Zakai NA, Kabagambe EK, Howard VJ, Safford MM, Irvin MR. Inflammation biomarkers and incident coronary heart disease: the Reasons for Geographic And Racial Differences in Stroke Study. Am Heart J 2022; 253:39-47. [PMID: 35810789 DOI: 10.1016/j.ahj.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individual inflammation biomarkers are associated with incident coronary heart disease (CHD) events. However, there is limited research on whether the risk for incident CHD is progressively higher with a higher number of inflammation biomarkers in abnormal levels. METHODS We used data from 15,758 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants aged ≥45 years without a history of CHD at baseline in 2003-2007. Abnormal levels of baseline high-sensitivity C-reactive protein, leukocyte count and serum albumin were defined as ≥3.8 mg/L (3rd tertile), ≥6.3 x 109 cells/L (3rd tertile), and <4.0 g/dL (1st tertile), respectively. The outcome was a composite of incident myocardial infarction or CHD death. RESULTS Overall, 38.9% (n = 6,123) had 0, 36.6% (n = 5,774) had 1, 19.8% (n = 3,113) had 2 and 4.7% (n = 748) had 3 biomarkers of inflammation in abnormal levels. Over a median follow-up of 11.4 years, 954 (6.1%) participants had incident CHD. The rate of incident CHD per 1000 person-years for individuals with 0, 1, 2, and 3 biomarkers of inflammation in abnormal levels was 4.4 (95% confidence interval [CI]: 3.9-5.0), 6.3 (95% CI: 5.6-6.9), 8.8 (95% CI: 7.8-9.9), and 10.6 (95% CI: 8.1-13.1), respectively. Multi-variable adjusted hazard ratios for incident CHD associated with 1, 2 and 3 versus no inflammation biomarker in abnormal levels were 1.26 (95% CI: 1.07-1.49), 1.72 (95% CI: 1.43-2.07), and 1.84 (95% CI: 1.37-2.47), respectively (P-trend < .001). CONCLUSIONS The number of inflammation markers in abnormal levels was associated with increased risk of incident CHD after multi-variable adjustment.
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Affiliation(s)
| | | | - Ninad S Chaudhary
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX
| | - Byron C Jaeger
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Mary Cushman
- Department of Medicine, Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Neil A Zakai
- Department of Medicine, Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Edmond K Kabagambe
- Ochsner Center for Outcomes Research, Division of Academics, Ochsner Health, New Orleans, LA; The Ochsner-Xavier Institute for Health Equity and Research (OXIHER) Ochsner Health, New Orleans, LA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
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Thayabaranathan T, Kim J, Cadilhac DA, Thrift AG, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Olaiya MT. Global stroke statistics 2022. Int J Stroke 2022; 17:946-956. [PMID: 35975986 PMCID: PMC9980380 DOI: 10.1177/17474930221123175] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary data on stroke epidemiology and the availability of national stroke clinical registries are important for providing evidence to improve practice and support policy decisions. AIMS To update the most current incidence, case-fatality, and mortality rates on stroke and identify national stroke clinical registries worldwide. METHODS We searched multiple databases (based on our existing search strategy) to identify new original papers, published between 1 November 2018 and 15 December 2021, that met ideal criteria for data on stroke incidence and case-fatality, and added these to the studies reported in our last review. To identify national stroke clinical registries, we updated our last search, using PubMed, from 6 February 2015 until 6 January 2022. We also screened reference lists of review papers, citation history of papers, and the gray literature. Mortality codes for International Classification of Diseases (ICD)-9 and ICD-10 were extracted from the World Health Organization (WHO) for each country providing these data. Population denominators were obtained from the United Nations (UN) or WHO (when data were unavailable in the UN database). Crude and adjusted stroke mortality rates were calculated using country-specific population denominators, and the most recent years of mortality data available for each country. RESULTS Since our last report in 2020, there were two countries (Chile and France) with new incidence studies meeting criteria for ideal population-based studies. New data on case-fatality were found for Chile and Kenya. The most current mortality data were available for the year 2014 (1 country), 2015 (2 countries), 2016 (11 countries), 2017 (10 countries), 2018 (19 countries), 2019 (36 countries), and 2020 (29 countries). Four countries (Libya, Solomon Islands, United Arab Emirates, and Lebanon) reported mortality data for the first time. Since our last report on registries in 2017, we identified seven more national stroke clinical registries, predominantly in high-income countries. These newly identified registries yielded limited information. CONCLUSIONS Up-to-date data on stroke incidence, case-fatality, and mortality continue to provide evidence of disparities and the scale of burden in low- and middle-income countries. Although more national stroke clinical registries were identified, information from these newly identified registries was limited. Highlighting data scarcity or even where a country is ranked might help facilitate more research or greater policy attention in this field.
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Affiliation(s)
- Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia,Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia,Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Pothineni NVK, Soliman EZ, Cushman M, Howard G, Howard VJ, Kasner SE, Judd S, Rhodes JD, Marchlinski FE, Deo R. Continuous cardiac rhythm monitoring post-stroke: A feasibility study in REGARDS. J Stroke Cerebrovasc Dis 2022; 31:106662. [PMID: 36115108 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Cardiac rhythm monitoring is increasingly used after stroke. We studied feasibility of telephone guided, mail-in ambulatory long-term cardiac rhythm monitoring in Black and White stroke survivors. MATERIALS AND METHODS;: We contacted 28 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had an ischemic stroke during follow-up. After obtaining informed consent by telephone, a noninvasive 14-day cardiac rhythm monitoring device (ZIO® XT patch; iRhythm Technologies, San Francisco, CA) was mailed to each participant. We evaluated the results of telephone consent, follow-up calls, compliance and wear time as the primary objective. Secondarily, we reported prevalence of atrial and ventricular arrhythmias. RESULTS The majority of those contacted (20/28 = 71%) agreed to enroll in the monitoring study. Non-participation was nominally more common in Black than White participants; 6/16 (37.5%) vs. 2/12 (17%). Of those who agreed, 15 participants (75%, 6 Black, 9 White) completed ambulatory monitoring with mean wear time 12.9 ± 2.5 days. Arrhythmias were observed in two-thirds of the 15 participants: AF in 2, brief atrial tachycardia in 12, NSVT in 2, premature ventricular contractions in 3, and pause or atrioventricular block in 2. CONCLUSIONS Non-invasive rhythm monitoring was feasible in this pilot from a large, national cohort study of stroke survivors that employed a telephone guided, mail-in monitoring system, and these preliminary results suggest a high prevalence of arrhythmias. Increased emphasis on recruitment strategies for Black stroke survivors may be required. We demonstrated a high yield of significant cardiac arrhythmias among post-stroke participants who completed monitoring.
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Affiliation(s)
- Naga Venkata K Pothineni
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Pennsylvania, 3400 Spruce Street, 9 Founders Cardiology, Philadelphia, PA, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J David Rhodes
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Francis E Marchlinski
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Pennsylvania, 3400 Spruce Street, 9 Founders Cardiology, Philadelphia, PA, USA
| | - Rajat Deo
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Pennsylvania, 3400 Spruce Street, 9 Founders Cardiology, Philadelphia, PA, USA.
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Wettersten N, Mital R, Cushman M, Howard G, Judd SE, Howard VJ, Safford MM, Hartmann O, Bergmann A, Struck J, Maisel A. Growth hormone concentration and risk of all-cause and cardiovascular mortality: The REasons for Geographic And Racial Disparities in Stroke (REGARDS) study. Atherosclerosis 2022; 359:20-26. [PMID: 36155327 DOI: 10.1016/j.atherosclerosis.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Identifying individuals at elevated risk for mortality, especially from cardiovascular disease, may help guide testing and treatment. Risk factors for mortality differ by sex and race. We investigated the association of growth hormone (GH) with all-cause and cardiovascular mortality in a racially diverse cohort in the United States. METHODS Among an age, sex and race stratified subgroup of 1046 Black and White participants from the REasons for Geographic And Racial Disparities in Stroke (REGARDS) study, 881 had GH available; values were log2 transformed. Associations with all-cause and cardiovascular mortality were assessed in the whole subgroup, and by sex and race, using multivariable Cox-proportional hazard models and C-index. RESULTS The mean age was 67.4 years, 51.1% were women, and 50.2% were Black participants. The median GH was 280 (interquartile range 79-838) ng/L. There were 237 deaths and 74 cardiovascular deaths over a mean of 8.0 years. In multivariable Cox analysis, GH was associated with higher risk of all-cause mortality per doubling (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.09-1.25) and cardiovascular mortality (HR 1.21, 95% CI 1.06-1.37). The association did not differ by sex or race (interaction p > 0.05). The addition of GH to a model of clinical variables significantly improved the C-index compared to clinical model alone for all-cause and cardiovascular death. CONCLUSIONS Higher fasting GH was associated with higher risk of all-cause and cardiovascular mortality and improved risk prediction, regardless of sex or race.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Rohit Mital
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Mary Cushman
- Departments of Medicine and Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Oliver Hartmann
- SphingoTec GmbH, Neuendorfstr. 15 A, 16761 Hennigsdorf, Germany
| | | | - Joachim Struck
- SphingoTec GmbH, Neuendorfstr. 15 A, 16761 Hennigsdorf, Germany
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA
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Sherman SE, Stoutenburg E, Long L, Juraschek SP, Cushman M, Howard VJ, Tracy RP, Judd SE, Kamin Mukaz D, Zakai NA, Plante TB. Abstract P079: Leptin And Risk Of Incident Hypertension In The Reasons For Geographic And Racial Differences In Stroke (REGARDS) Cohort Study. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Leptin is an anorexigenic and sympathoexcitatory adipokine strongly associated with obesity and associated with hypertension in animal models. Whether leptin is associated with hypertension incidence independent of obesity is unclear.
Methods:
REGARDS recruited 30,239 Black or White adults aged ≥45 years recruited from 48 US contiguous states in 2003-07 with a second visit in 2013-16. Baseline serum leptin was measured by ELISA in a sex- and race-stratified sample of 4,400 REGARDS participants. Modified Poisson regression estimated relative risk (RR) of incident hypertension (140/90 mm Hg threshold or use of antihypertensives) per higher leptin tertile, stratified by a BMI of 30 kg/m
2
, adjusting for known confounders.
Results:
Among the 1,834 participants without prevalent hypertension (mean [SD] age 62, 56% women, 25% Black adults), median follow-up was 9 years. Incident hypertension developed in 35%. BMI significantly modified the relationship between leptin and incident hypertension (P-interaction <0.001) such that higher leptin was associated with greater hypertension risk in the crude model among those with BMI <30, but not ≥30, kg/m
2
(
Figure
). This association was fully attenuated when adjusting for waist circumference and BMI.
Conclusions:
Leptin is associated with hypertension among normal weight but not obese adults in REGARDS. Adiposity may be on the causal pathway between leptin levels and obesity.
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Affiliation(s)
| | | | - Leann Long
- UNIVERSITY OF ALABAMA AT BIRMINGHAM, Birmingham, AL
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Howard VJ, Spence JD. In Memoriam: Jim Toole, MD: Ahead of His Time. Stroke 2022; 53:2713-2716. [PMID: 35994679 DOI: 10.1161/strokeaha.122.037401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.)
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada (J.D.S.)
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Sherman SE, Stoutenburg E, Long L, Juraschek SP, Cushman M, Howard VJ, Tracy RP, Judd SE, Kamin Mukaz D, Zakai N, Plante TB. Abstract P078: Excess Risk Of Hypertension Among Black Adults And The Mediating Effects Of Leptin: The Reasons For Geographic And Racial Differences In Stroke (REGARDS) Cohort Study. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Leptin is a hypertension-related adipokine. We previously found leptin to associate with greater risk of incident hypertension in non-obese adults. Relative to White adults, Black adults have higher circulating leptin concentration. As such, leptin may be a mediator of the excess burden of incident hypertension among Black adults.
Methods:
REGARDS recruited 30,239 Black or White adults aged ≥45 years from 48 US states. Leptin was measured from baseline samples among 4,400 participants who attended 2 visits 9 years apart. Modified Poisson regression estimated the relative risk (RR) of incident hypertension (≥140/90 mmHg or use of antihypertensives) of Black relative to White adults, adjusting for risk factors. Inverse odds ratio weighting estimated the % mediation by leptin of the excess hypertension RR among Black relative to White participants in 1,000 bootstrapped samples.
Results:
In 1,834 participants without prevalent hypertension (mean age 62, 56% women, 25% Black adults), incident hypertension developed in 47% of Black & 32% of White participants. The
Table
presents the RR for incident hypertension among Black relative to White adults. In the crude model, Black adults had a 52% greater risk of incident hypertension and leptin mediated 20% of this disparity. Similar associations were seen when adjusting for demographics, behaviors, and diseases. After adjusting for measures of adiposity, leptin no longer mediated the disparity.
Conclusions:
Leptin mediated approximately 20% of the Black-White disparity in hypertension incidence in crude and some adjusted models. These data support that this mediation acts through adiposity.
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Affiliation(s)
| | - Eric Stoutenburg
- Larner College of Medicine at the Univ of Vermont, Burlington, VT
| | - Leann Long
- UNIVERSITY OF ALABAMA AT BIRMINGHAM, Birmingham, AL
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Meschia JF, Brott TG, Voeks J, Howard VJ, Howard G. Stroke Symptoms As a Surrogate in Stroke Primary Prevention Trials: The CREST Experience. Neurology 2022; 99:e2378-e2384. [PMID: 36028326 DOI: 10.1212/wnl.0000000000201188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND and Purpose: The use of surrogate endpoints can decrease sample size while maintaining statistical power. This report considers incident stroke symptoms as a surrogate endpoint in a post-hoc analysis of asymptomatic patients from the multicenter, randomized Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST). METHODS CREST assessed stroke symptoms using the Questionnaire for Verifying Stroke-free Status (QVSS) at baseline and follow-up. While the primary analysis of CREST defined "asymptomatic" as having been free of stroke/TIA for 180 days, herein the population was further restricted by requiring no stroke symptoms at baseline. Incident adjudicated stroke was defined the same as for the primary analysis; incident stroke symptoms was defined as developing ≥1 stroke symptom in follow-up. Treatment differences between stenting (CAS) and endarterectomy (CEA) were assessed for three endpoints: adjudicated stroke, stroke symptoms, and adjudicated stroke or stroke symptoms. RESULTS The cohort included 826 of the 1181 asymptomatic patients in CREST. Adjudicated stroke events occurred in 44 patients and incident stroke symptoms occurred in 183. Analysis of adjudicated stroke endpoints demonstrated a non-significant hazard ratio (HR) for CAS compared to CEA of 1.02 (95% confidence interval [CI], 0.57-1.85). The corresponding HR for the incident stroke symptoms outcome was 1.54 (95% CI, 1.15-2.08), and the HR for the composite outcome of adjudicated stroke or incident symptoms was 1.38 (95% CI, 1.04-1.83), both significant. CONCLUSIONS The low stroke event rates in asymptomatic patients challenges the assessment of CAS-versus-CEA treatment differences. Incorporating incident stroke symptoms as a surrogate outcome increased the number of events by over 4-fold. The analysis demonstrated a previously unreported significant difference in cerebrovascular risk with CAS compared to CEA. We propose that broadening the endpoints of primary stroke prevention trials to include surrogate events like incident stroke symptoms could make trials more feasible.
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Affiliation(s)
| | - Thomas G Brott
- The Department of Neurology, Mayo Clinic, Jacksonville, FL
| | - Jenifer Voeks
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL
| | - George Howard
- Department of Biostatistics, University of Alabama, Birmingham, AL
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Gilchrist SC, Bennett A, Judd SE, Akinyemiju T, Howard VJ, Hooker SP, Cushman M, Diaz KM. Sedentary Behavior and Physical Functioning in Middle-Aged and Older Adults Living in the U.S.: The REGARDS Study. Med Sci Sports Exerc 2022; 54:1897-1903. [DOI: 10.1249/mss.0000000000002983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tarp J, Fagerland MW, Dalene KE, Johannessen JS, Hansen BH, Jefferis BJ, Whincup PH, Diaz KM, Hooker S, Howard VJ, Chernofsky A, Larson MG, Spartano NL, Vasan RS, Dohrn IM, Hagströmer M, Edwardson C, Yates T, Shiroma EJ, Dempsey PC, Wijndaele K, Anderssen SA, Lee IM, Ekelund U. Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies. Br J Sports Med 2022; 56:725-732. [PMID: 34876405 PMCID: PMC9209690 DOI: 10.1136/bjsports-2021-104827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The joint associations of total and intensity-specific physical activity with obesity in relation to all-cause mortality risk are unclear. METHODS We included 34 492 adults (72% women, median age 62.1 years, 2034 deaths during follow-up) in a harmonised meta-analysis of eight population-based prospective cohort studies with mean follow-up ranging from 6.0 to 14.5 years. Standard body mass index categories were cross-classified with sample tertiles of device-measured total, light-to-vigorous and moderate-to-vigorous physical activity and sedentary time. In five cohorts with waist circumference available, high and low waist circumference was combined with tertiles of moderate-to-vigorous physical activity. RESULTS There was an inverse dose-response relationship between higher levels of total and intensity-specific physical activity and mortality risk in those who were normal weight and overweight. In individuals with obesity, the inverse dose-response relationship was only observed for total physical activity. Similarly, lower levels of sedentary time were associated with lower mortality risk in normal weight and overweight individuals but there was no association between sedentary time and risk of mortality in those who were obese. Compared with the obese-low total physical activity reference, the HRs were 0.59 (95% CI 0.44 to 0.79) for normal weight-high total activity and 0.67 (95% CI 0.48 to 0.94) for obese-high total activity. In contrast, normal weight-low total physical activity was associated with a higher risk of mortality compared with the obese-low total physical activity reference (1.28; 95% CI 0.99 to 1.67). CONCLUSIONS Higher levels of physical activity were associated with lower risk of mortality irrespective of weight status. Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low.
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Affiliation(s)
- Jakob Tarp
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Morten W Fagerland
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Knut Eirik Dalene
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Bjørge H Hansen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Barbara J Jefferis
- Primary Care and Population Health, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - Keith M Diaz
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
| | - Steven Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ariel Chernofsky
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Nicole L Spartano
- Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ramachandran S Vasan
- Departments of Medicine and Epidemiology, Boston University School of Medicine and Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ing-Mari Dohrn
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Charlotte Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland, USA
| | - Paddy C Dempsey
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Physical Activity and Behavioural Epidemiology Laboratories, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Sigmund A Anderssen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - I-Min Lee
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Oelsner EC, Krishnaswamy A, Balte PP, Allen NB, Ali T, Anugu P, Andrews H, Arora K, Asaro A, Barr RG, Bertoni AG, Bon J, Boyle R, Chang AA, Chen G, Coady S, Cole SA, Coresh J, Cornell E, Correa A, Couper D, Cushman M, Demmer RT, Elkind MSV, Folsom AR, Fretts AM, Gabriel KP, Gallo L, Gutierrez J, Han MLK, Henderson JM, Howard VJ, Isasi CR, Jacobs Jr DR, Judd SE, Mukaz DK, Kanaya AM, Kandula NR, Kaplan R, Kinney GL, Kucharska-Newton A, Lee JS, Lewis CE, Levine DA, Levitan EB, Levy B, Make B, Malloy K, Manly JJ, Mendoza-Puccini C, Meyer KA, Min YI, Moll M, Moore WC, Mauger D, Ortega VE, Palta P, Parker MM, Phipatanakul W, Post WS, Postow L, Psaty BM, Regan EA, Ring K, Roger VL, Rotter JI, Rundek T, Sacco RL, Schembri M, Schwartz DA, Seshadri S, Shikany JM, Sims M, Hinckley Stukovsky KD, Talavera GA, Tracy RP, Umans JG, Vasan RS, Watson K, Wenzel SE, Winters K, Woodruff PG, Xanthakis V, Zhang Y, Zhang Y, C4R Investigators FT. Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study: Study Design. Am J Epidemiol 2022; 191:1153-1173. [PMID: 35279711 PMCID: PMC8992336 DOI: 10.1093/aje/kwac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/26/2022] [Accepted: 02/09/2022] [Indexed: 01/26/2023] Open
Abstract
The Collaborative Cohort of Cohorts for COVID-19 Research (C4R) is a national prospective study of adults comprising 14 established US prospective cohort studies. Starting as early as 1971, investigators in the C4R cohort studies have collected data on clinical and subclinical diseases and their risk factors, including behavior, cognition, biomarkers, and social determinants of health. C4R links this pre-coronavirus disease 2019 (COVID-19) phenotyping to information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and acute and postacute COVID-related illness. C4R is largely population-based, has an age range of 18-108 years, and reflects the racial, ethnic, socioeconomic, and geographic diversity of the United States. C4R ascertains SARS-CoV-2 infection and COVID-19 illness using standardized questionnaires, ascertainment of COVID-related hospitalizations and deaths, and a SARS-CoV-2 serosurvey conducted via dried blood spots. Master protocols leverage existing robust retention rates for telephone and in-person examinations and high-quality event surveillance. Extensive prepandemic data minimize referral, survival, and recall bias. Data are harmonized with research-quality phenotyping unmatched by clinical and survey-based studies; these data will be pooled and shared widely to expedite collaboration and scientific findings. This resource will allow evaluation of risk and resilience factors for COVID-19 severity and outcomes, including postacute sequelae, and assessment of the social and behavioral impact of the pandemic on long-term health trajectories.
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Affiliation(s)
- Elizabeth C Oelsner
- Correspondence to Dr. Elizabeth C Oelsner, MD MPH, Herbert Irving Associate Professor of Medicine, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168 Street, PH9-105K New York, NY 10032 Tel: 917-880-7099
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Albright KC, Howard VJ. Prognosis After Stroke: Do We Have What We Need to Talk With Patients and Their Families? Neurology 2022; 98:1001-1002. [PMID: 35649729 DOI: 10.1212/wnl.0000000000200754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Karen C Albright
- From the Departments of Neurology and Pharmacology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham
| | - Virginia J Howard
- From the Departments of Neurology and Pharmacology (K.C.A.), SUNY Upstate Medical University, Syracuse, NY; and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham.
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